Acute exacerbated COPD: room for improvement in key elements of care

Stefan Markun,1,* Daniel P Franzen,2,* Kaba Dalla Lana,1 Swantje Beyer,3 Stephan Wieser,4 Thomas Hess,3 Malcolm Kohler,2 Thomas Rosemann,1 Oliver Senn,1 Claudia Steurer-Stey1,5 1Institute of Primary Care, 2Department of Pneumology, University Hospital Zurich, University of Zurich, Zurich, 3Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur, 4Department of Pneumology, City Hospital Waid, 5MediX Group Practice Ltd, Zurich, Switzerland *These authors contributed equally to this work Introduction: Hospitalizations because of acute exacerbated COPD (AECOPD) are a major burden to patients and the health care system. Interventions during acute and post-acute hospital care exist not only to improve short-term outcomes but also to prevent future exacerbations and disease progression. We aimed at measuring the implementation rates of acute and post-acute hospital care interventions for AECOPD.Methods: We performed 24 months (January 1, 2012, to December 31, 2013) retrospective medical chart review of consecutive cases hospitalized to one of three public hospitals in the canton of Zurich due to AECOPD. Implementation rates of five acute care and seven post-acute care interventions were assessed.Results: Data from 263 hospitalizations (61% male, mean age 68.5 years, 47% active smokers) were analyzed. The median length of stay was 9 days (interquartile range [IQR] 6–12 days). In all, 32% of hospitalizations were caused by individuals with previous hospitalizations because of AECOPD. Implementation rates of four acute care interventions were >75% (lowest was appropriate antibiotic therapy with 56%). Compared to this, implementation rates of five post-acute care interventions were <25% (lowest was patient education and self-management advice with 2%).Conclusion: The results of this audit revealed room for improvement mainly in post-acute care interventions for AECOPD. Keywords: audit, COPD, exacerbation, guideline adherence, hospital medicine, performance of car