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COPD in emergency care

Acute worsening of Chronic Obstructive Pulmonary Disease (COPD) – exacerbations or lung attacks – are common occurrences at all stages of the disease. Patients present with increasing breathlessness, cough and sputum production. They attend hospital emergency departments (ED) and may or may not be admitted. Lung attacks carry a three-month mortality rate of 14%, more than an acute ST elevation myocardial infarction.

Despite this severity data the treatment of these patients is haphazard and variable. Often they are all treated in the same manner, a ‘one size fits all’ approach.

Little is known about what happens to those who present to EDs and who are not admitted. There are key interventions, which are effective in optimising care. Are they initiated and do these COPD patients get the care they need? At present there is no evidence that can guide care optimisation, but it is highly likely that care provision for COPD is suboptimal and variable. This will lead to poor outcomes, both immediately and longer term.

Scope

This project covers the EDs at all of the acute trusts in the Oxford AHSN region:

  • Oxford University Hospitals
  • Buckinghamshire Healthcare
  • Frimley Health
  • Great Western Hospitals
  • Milton Keynes University Hospital
  • Royal Berkshire.

Outcomes

  • To determine the clinical pathway followed by COPD patients attending ED who are not admitted
  • Review treatment and follow-up plans and assess how robust they are, comparing key clinical outcomes to see if the two items correlate
  • From the collected data design and implement a toolkit for COPD management and care in ED which will reduce morbidity and mortality and enhance the clinical security of COPD patients
  • Standardise the clinical pathway for treatment of COPD in EDs across the region
  • Reduce reattendance at EDs.
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