Use of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study.

Hdl Handle:
http://hdl.handle.net/10147/311604
Title:
Use of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study.
Authors:
McCarthy, Cormac; Brennan, John R; Brown, Lindsay; Donaghy, Deirdre; Jones, Patricia; Whelan, Rory; McCormack, Niamh; Callanan, Ian; Ryan, John; McDonnell, Timothy J
Citation:
Use of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study. 2013, 8:605-11 Int J Chron Obstruct Pulmon Dis
Journal:
International journal of chronic obstructive pulmonary disease
Issue Date:
2013
URI:
http://hdl.handle.net/10147/311604
DOI:
10.2147/COPD.S52883
PubMed ID:
24348033
Abstract:
Aim: To determine the efficacy and usefulness of a chronic obstructive pulmonary disease (COPD) care bundle designed for the initial management of acute exacerbations of COPD and to assess whether it improves quality of care and provides better outcomes. Introduction: The level of care provided in the emergency department (ED) for COPD exacerbations varies greatly, and there is a need for a more systematic, consistent, evidence-based quality improvement approach to improve outcomes and costs. Methods: A prospective before and after study was carried out in a university teaching hospital. Fifty consecutive patients were identified in the ED with COPD exacerbations and their management was reviewed. Following the education of ED staff and the implementation of a COPD care bundle, the outcome for 51 consecutive patients was analyzed. This COPD care bundle consisted of ten elements considered essential to the management of COPD exacerbations and was scored 0–10 according to the number of items on the checklist implemented correctly. Results: Following implementation, the mean bundle score out of 10 improved from 4.6 to 7 (P,0.001). There was a significant decrease in the unnecessary use of intravenous corticosteroids from 60% to 32% (P=0.003) and also a marked improvement in the use of oxygen therapy, with appropriate treatment increasing from 76% to 96% (P=0.003). Prophylaxis for venous thromboembolism also improved from 54% to 73% (P=0.054). The 30-day readmission rate did not significantly improve. Conclusion: The use of a bundle improves the delivery of care for COPD exacerbations in the ED. There is more appropriate use of therapeutic interventions, especially oxygen therapy and intravenous corticosteroids.
Item Type:
Article
Language:
en
Keywords:
CHRONIC AIRWAY DISEASE; EMERGENCY MEDICAL CARE; HEALTHCARE AND HEALTH SERVICES
Local subject classification:
CARE PLAN
ISSN:
1178-2005

Full metadata record

DC FieldValue Language
dc.contributor.authorMcCarthy, Cormacen_GB
dc.contributor.authorBrennan, John Ren_GB
dc.contributor.authorBrown, Lindsayen_GB
dc.contributor.authorDonaghy, Deirdreen_GB
dc.contributor.authorJones, Patriciaen_GB
dc.contributor.authorWhelan, Roryen_GB
dc.contributor.authorMcCormack, Niamhen_GB
dc.contributor.authorCallanan, Ianen_GB
dc.contributor.authorRyan, Johnen_GB
dc.contributor.authorMcDonnell, Timothy Jen_GB
dc.date.accessioned2014-01-20T16:12:51Z-
dc.date.available2014-01-20T16:12:51Z-
dc.date.issued2013-
dc.identifier.citationUse of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study. 2013, 8:605-11 Int J Chron Obstruct Pulmon Disen_GB
dc.identifier.issn1178-2005-
dc.identifier.pmid24348033-
dc.identifier.doi10.2147/COPD.S52883-
dc.identifier.urihttp://hdl.handle.net/10147/311604-
dc.description.abstractAim: To determine the efficacy and usefulness of a chronic obstructive pulmonary disease (COPD) care bundle designed for the initial management of acute exacerbations of COPD and to assess whether it improves quality of care and provides better outcomes. Introduction: The level of care provided in the emergency department (ED) for COPD exacerbations varies greatly, and there is a need for a more systematic, consistent, evidence-based quality improvement approach to improve outcomes and costs. Methods: A prospective before and after study was carried out in a university teaching hospital. Fifty consecutive patients were identified in the ED with COPD exacerbations and their management was reviewed. Following the education of ED staff and the implementation of a COPD care bundle, the outcome for 51 consecutive patients was analyzed. This COPD care bundle consisted of ten elements considered essential to the management of COPD exacerbations and was scored 0–10 according to the number of items on the checklist implemented correctly. Results: Following implementation, the mean bundle score out of 10 improved from 4.6 to 7 (P,0.001). There was a significant decrease in the unnecessary use of intravenous corticosteroids from 60% to 32% (P=0.003) and also a marked improvement in the use of oxygen therapy, with appropriate treatment increasing from 76% to 96% (P=0.003). Prophylaxis for venous thromboembolism also improved from 54% to 73% (P=0.054). The 30-day readmission rate did not significantly improve. Conclusion: The use of a bundle improves the delivery of care for COPD exacerbations in the ED. There is more appropriate use of therapeutic interventions, especially oxygen therapy and intravenous corticosteroids.en_GB
dc.language.isoenen
dc.rightsArchived with thanks to International journal of chronic obstructive pulmonary diseaseen_GB
dc.subjectCHRONIC AIRWAY DISEASEen_GB
dc.subjectEMERGENCY MEDICAL CAREen_GB
dc.subjectHEALTHCARE AND HEALTH SERVICESen_GB
dc.subject.otherCARE PLANen_GB
dc.titleUse of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study.en_GB
dc.typeArticleen
dc.identifier.journalInternational journal of chronic obstructive pulmonary diseaseen_GB
dc.description.fundingNo fundingen
dc.description.provinceLeinsteren
dc.description.peer-reviewpeer-reviewen
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