A study has been published which shows that while some aspects of care have improved for chronic obstructive pulmonary disease over the last six years, standards differ greatly across England and Wales.
The latest national COPD clinic audit, commissioned by the Healthcare Quality Improvement Partnership, is believed to be the biggest collected worldwide to date, comprising 13,414 patients admitted to hospital as a result of their COPD flaring-up. It notes that mortality in hospital has reduced from 7.8% in 2008 to 4.3% in 2014, “though the reason for this is far from clear,” and that the median length of stay has reduced from five to four days over the same time. There has been a large rise in the number of patients able to leave hospital early due to early/supported discharge schemes – from 18% six years ago to 40% in 2014.
However, the audit found that 45% of patients were discharged within three days, many of whom had no contact with respiratory specialists, and one in five patients were not seen by a respiratory expert at all during their stay. Also, correct prescribing of oxygen, known to reduce the risk of death, was absent in the care of 32% of patients, while recording of spirometry, the key diagnostic test for COPD, was available in only 46% of cases, worse than the 54% found in the 2008 audit.
Among the recommendations in the report are that patients admitted with COPD exacerbation should receive a respiratory specialist opinion within 24 hours, seven days a week and hospitals “should appraise carefully their staff rosters at weekends and on Mondays”; the former has the lowest rate of discharges and the latter the highest rate of admission and longest times to clinical review.
Also it suggests there needs to be better co-ordination of care at the point of discharge,”and better linkage into community COPD services.”