A new report from the Royal College of Physicians shows that 43% of patients admitted for hospital treatment of chronic obstructive pulmonary disease (COPD) were readmitted at least once in the 3 months following discharge, representing a considerable increase from 33% in 2008.
COPD is responsible for 5% of annual deaths globally, is the fifth biggest killer in the UK and is the only major cause of death that is on the increase.
COPD: Who cares when it matters most?, the National COPD Audit Programme’s report for secondary care outcomes in 2014, also demonstrates that, although COPD was the single most common cause of readmission, over 50% of readmissions were in older people with multiple health conditions. Many of the patients had also been admitted to hospital in the months prior to the audit.
There have also undoubtedly been improvements in the safety and efficiency of COPD care. The report shows that inpatient mortality has decreased from 7.9% in 2003 to 4.3% in 2014. Fewer patients are dying after discharge from hospital. There has been a marked decrease in the average length of stay in hospital for acute exacerbation of COPD, which fell from 6 days to 4 days in the same period.
The National COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP), as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) and led by the RCP, working closely with a range of key stakeholders, including the British Thoracic Society, Primary Care Respiratory Society UK, British Lung Foundation and Royal College of General Practitioners.
Recommendations to improve treatment and care of patients with COPD include:
- early identification of individuals at risk of deterioration
- careful assessment of patients with multiple healthcare needs and conditions
- improved discharge planning, particularly for vulnerable and frail patients
- the development of integrated approaches to COPD care.
These recommendations are aligned with the priority of the NHS to improve integrated care. The importance of this was highlighted by the RCP Future Hospital Programme (FHP) in the Future Hospital Commission report, which evidenced in Integrated care – taking specialist medical care beyond the hospital walls how outcomes for patients are improved by better working across care sectors.
Dr Robert Stone, consultant respiratory physician at Taunton and Somerset NHS Foundation Trust and clinical lead for the National COPD Audit, said:
There have been some very encouraging improvements in efficiency and patient outcomes. However, it is clear from the data in this report that significant improvements must be made in order to support the needs of this complex and fragile patient group.
Emphasis must be placed on the development of an integrated care system that focuses on the needs and management of older patients and those with more than one health condition.
It is vital that primary, secondary and social care services work better together to support people suffering with COPD, placing them firmly at the centre of their own care.
Carol Stonham MBE, primary care respiratory nurse specialist in Gloucestershire and nurse lead for Primary Care Respiratory Society UK (PCRS UK), said:
There is so much for people with COPD to gain if we work as this report suggests in an integrated way across traditional boundaries.
We need to share what we know to identify the most high-risk patients – to utilise the passion and knowledge of respiratory specialists in secondary and community care to enhance the offer to these patients who manage their illness in the community.
We need to work with social care to enable patients to get home more quickly with the right support. We have to think beyond the old divides if care is to be effective and sustainable for patients with COPD.