COPD: Who cares when it matters most? – outcomes report 2014

COPD: Who cares when it matters most? is a supplementary report detailing the outcomes of the cohort of patients included in the 2014 clinical audit of COPD exacerbations in England.

It is the third of the reports produced from the 2014 audit, following the publication of organisational and clinical audit reports in 2014 and 2015 respectively. There is also a quality improvement (QI) focused slide set.

Key recommendations

For commissioners

To reduce readmissions and frequent admissions, we suggest that integrated COPD pathways and services for COPD are made widely available, and that local provision of high value interventions is reviewed.
There is a need to develop supported discharge and admission avoidance services for COPD, as well as better links into mechanisms of support for vulnerable, frail patients. Coordinated multidisciplinary working across health and social sectors is necessary.

For providers

Secondary care

To reduce inpatient mortality, early respiratory specialist review and timely provision of non-invasive ventilation (NIV) is essential.
Every effort should be made to initiate treatment escalation plans (TEPs) within 24 hours of admission.
There should be better identification of patients at risk of imminent or later deterioration, and we suggest space is incorporated into admission documentation to include relevant COPD-related scores and test results.
To reduce readmission, hospital teams should think carefully before discharge about the total needs of COPD patients, including risk of readmission, using not only respiratory tools but also established multimorbidity and frailty scores to aid their thinking.
Admitting teams should also pay greater attention to the recent admission history of their readmitted patients, to understand what has caused the readmission and to discern how care could be optimised.

Primary care

To reduce readmission, we recommend early review of every discharged case by a suitable primary care team member, to identify issues that may place the patient at increased risk of readmission and to ensure high value interventions have been addressed.
We recommend that primary care teams devote resource to identifying, reviewing and enhancing the management of those COPD patients on their lists who are deemed at particular risk of hospital admission.

How to use this report

This report comes in two parts:

National supplementary report, presenting the key findings and recommendations.
Results and data analysis report, containing the full data analyses. The data are presented largely in tabular form, with explanatory notes throughout.

The reports are based on data extracted from the Office of National Statistics (ONS) and Hospital Episode Statistics (HES), and relate to patients whose index admission with COPD exacerbation occurred during the audit period (February–April 2014) in England.

The national supplementary report is relevant to anyone with an interest in COPD and will enable lay people, as well as experts, to understand the outcomes of people admitted to acute NHS units in England with acute exacerbations of COPD. The full data analyses contained in the results and data analysis report have been made available to the interested reader but it is not necessary to review them to appreciate the key messages.

This report is designed to provide readers with a basis for identifying areas in need of change and to facilitate development of improvement programmes that are relevant not only to units, but also to commissioners and policymakers.