This organisational audit of COPD care was run in parallel with the 2014 secondary care clinical audit, with data collection via a bespoke web-based audit tool. The datasets for each part of the audit were developed and refined during 2013 by the Workstream Steering Group, with input from the NHS and British Thoracic Society (BTS) COPD leads, and in light of feedback from a short pilot audit run in September 2013.
These recommendations are directed with equal weight towards commissioners and providers, as they are relevant to both good clinical practice and the commissioning of COPD services. We suggest that they are discussed carefully at trust/CCG board level and within local respiratory programme groups.
- Patients admitted with COPD exacerbation should receive a respiratory specialist opinion within 24 hours.
- Patients with COPD exacerbation who need onward hospital care after their stay on the medical admissions unit should be managed in a respiratory ward.
- All patients requiring non-invasive ventilation (NIV) should have access to level 2 care.
- Respiratory wards should be staffed to run at least one of the level 2 beds, the number being dependent upon demand and size of the hospital, in which NIV can be administered according to accepted clinical guidelines.
- Intensive care unit (ICU) outreach services should be available 24 hours, 7 days a week.
- All hospitals/units should have a fully-funded and resourced smoking cessation programme delivered by dedicated smoking cessation practitioners.
- All hospitals/units should make spirometry results accessible from every computer desktop; there should be a data sharing agreement between primary and secondary care that allows general practice spirometry data to be made universally available.
- Post-discharge pulmonary rehabilitation services should be available within 4 weeks of referral.
- Each unit should nominate a respiratory clinical lead for discharge care and integrating services, this individual having designated time to improve the uptake of discharge bundles, improve the quality of discharge information and work collaboratively with colleagues in primary care to improve integrated pathways for COPD.
- Acute and community providers, primary care, patient groups and commissioners should work collaboratively via local respiratory programme groups to improve coordinated care and formalise COPD pathways; respiratory specialists should take a lead in this process, forming such groups if they do not exist at present.