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Management of acute COPD exacerbations in Australia : Do we follow the guidelines?
Cousins, Joyce L. Wood-Baker, Richard Wark, Peter A. B. Yang, Ian A. Gibson, Peter G. Hutchinson, Anastasia Sajkov, Dimitar Hiles, Sarah A. Samuel, Sameh McDonald, Vanessa M.
Cousins, Joyce L.
Wood-Baker, Richard
Wark, Peter A. B.
Yang, Ian A.
Gibson, Peter G.
Hutchinson, Anastasia
Sajkov, Dimitar
Hiles, Sarah A.
Samuel, Sameh
McDonald, Vanessa M.
Abstract
Objective
We aimed to assess adherence to the Australian national guideline (COPD-X) against audited practice, and to document the outcomes of patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (COPD) at discharge and 28 days after.
Methods
A prospective clinical audit of COPD hospital admission from five tertiary care hospitals in five states of Australia was conducted. Post-discharge follow-up was conducted via telephone to assess for readmission and health status.
Results
There were 207 admissions for acute exacerbation (171 patients; mean 70.2 years old; 50.3% males). Readmission rates at 28 days were 25.4%, with one (0.6%) death during admission and eight (6.1%) post-discharge within 28 days. Concordance to the COPD-X guidance was variable; 22.7% performed spirometry, 81.1% had blood gases collected when forced expiratory volume in 1 s was <1 L, 99.5% had chest radiography performed, 95.1% were prescribed systemic corticosteroids and 95% were prescribed antibiotic therapy. There were 89.1% given oxygen therapy and 92.6% when arterial oxygen tension was <80 mmHg; 65.6% were given ventilatory assistance when pH was <7.35. Only 32.4% were referred to pulmonary rehabilitation but 76.8% had general practitioner follow-up arranged.
Conclusion
When compared against clinical practice guidelines, we found important gaps in management of patients admitted with COPD throughout tertiary care centres in Australia. Strategies to improve guideline uptake are needed to optimise care.
Keywords
Date
2020
Type
Journal article
Journal
ERJ Open Research
Book
Volume
6
Issue
2
Page Range
1-9
Article Number
Article 00270-2019
ACU Department
School of Nursing, Midwifery and Paramedicine
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY-NC 4.0
File Access
Open
Notes
Copyright © ERS 2020 This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0 (https://creativecommons.org/licenses/by-nc/4.0/).