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

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    Authors
    McCarthy, Cormac
    Brennan, John R
    Brown, Lindsay
    Donaghy, Deirdre
    Jones, Patricia
    Whelan, Rory
    McCormack, Niamh
    Callanan, Ian
    Ryan, John
    McDonnell, Timothy J
    Issue Date
    2013
    Keywords
    CHRONIC AIRWAY DISEASE
    EMERGENCY MEDICAL CARE
    HEALTHCARE AND HEALTH SERVICES
    Local subject classification
    CARE PLAN
    
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    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
    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
    ISSN
    1178-2005
    ae974a485f413a2113503eed53cd6c53
    10.2147/COPD.S52883
    Scopus Count
    Collections
    St. Vincent's University Hospital

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