Implementing Early supported discharge, Chronic Obstructive Pulmonary Disease, Community, Primary care, Multidisciplinary team, Change management, Kotter's 8-step Model.

Aim: The purpose of this paper is topresent the development and implementation ofEarly Supported Discharge (ESD) for thosepatients admitted to hospital with an acuteexacerbation of chronic obstructive pulmonarydisease (COPD). It also outlines thecollaboration between secondary and primarycare using Kotters 8-step change model.Background: Acute exacerbation of chronicobstructive pulmonary disease (COPD) accountsfor 1:20 emergency admissions daily, 500 ofwhich are admitted spending an average of 6.5days in hospital. Alternatives to managingexacerbation of COPD in a hospital setting werefirst suggested by the Royal College of Physiciansin 1981. Emergency admissions for COPD placea significant burden on the resources of the NHS.Methods: Kotters 8-step model of change wasused in this study. All adult patients (55 years orolder) admitted to the Acute Medical ward withan exacerbation of COPD were assessed for theirsuitability for ESD. The period of the study wasfrom February to June 2011. The service wasoperational from Monday to Thursday, andbetween the hours of 09.00 and 12 midday.Patients admitted with the diagnosis of COPDwere identified by;• Accessing admissions information via ahospital information system• Referral from nurse in charge ofadmissions ward• Referral from Doctors.Results: The approach adopting a change modelhas resulted in a period of six months 27 patientsbeing discharged under the ESD scheme. Onlyone patient was readmitted within 30 days.Conclusion: Approaching the change in smallersteps encourages reflection and development ofleadership skills, and analysing the small stepsallowed the development of a clear strategywhich moved ESD forward. This servicedevelopment has been a very positive experience,in the main due to the collaboration between theRespiratory Nurses and COPD Team