Needs Assessment and Identification of the Multifaceted COPD Care Bundle in the Emergency Department of a Tertiary Hospital in Nepal. Int J Chron Obstruct Pulmon Dis 2021;16:125-136
Date
02/02/2021Pubmed ID
33519197Pubmed Central ID
PMC7837591DOI
10.2147/COPD.S285744Scopus ID
2-s2.0-85099654331 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
PURPOSE: Acute care of patients with exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department (ED) is crucial, however not studied extensively in Nepal. The purpose of this study is to identify the opportunities for succinct measures to optimize the AECOPD care in ED with a multifaceted bundle care approach in a resource-limited setting.
METHODS: We conducted a prospective cross-sectional observational study as an initial baseline stage of the quality improvement project. Demographic data, clinical characteristics, the current diagnosis and treatment performances of AECOPD were recorded. The primary outcome measures were 30-day ED revisit and near-fatal events which were compared with other variables and performances with binary and logistic regression. The multidisciplinary team performed the root cause and Pareto analysis to identify the potential gaps in the AECOPD care.
RESULTS: The AECOPD performance measures were suboptimal. Written AECOPD emergency management clinical guidelines and advice regarding pulmonary rehabilitation were absent. Among the 249 AECOPD encounters, bilevel positive-airway pressure ventilation was started in 6.4%. At discharge, 11.8% and 39.7% were given oral steroids and antibiotics respectively; 2.2% were advised vaccination. Near-fatal events and 30-day revisit occurred in 19% and 38.2% of the encounters respectively. Those who required domiciliary oxygen had significantly higher 30-day revisits (OR=2.5; 95% CI=1.43-4.4; P value =0.001) as did those who were previously admitted (OR=1.98; 95% CI 1.11-3.59; P value =0.022). Those who had a 30-day revisit had increased near-fatal events (OR=2.86; 95% CI=1.362-6.18; P value =0.006). The opportunities for improving the ED care were identified and feasible interventions and their indicators are summarized for future implementation.
CONCLUSION: The current COPD performance measures were suboptimal with high 30-day revisit and near-fatal outcomes. We suggest the urgent implementation of the enlisted feasible bundles-care involving multifaceted team and protocol-based management plans for AECOPD in a busy resource-limited ED.
Author List
Shrestha R, Shrestha AP, Sonnenberg T, Mistry J, Shrestha R, MacKinney TAuthors
Theodore MacKinney MD Professor in the Medicine department at Medical College of WisconsinTaylor Sonnenberg MD, MSGH Associate Professor in the Emergency Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Cross-Sectional StudiesDisease Progression
Emergency Service, Hospital
Humans
Needs Assessment
Nepal
Patient Care Bundles
Prospective Studies
Pulmonary Disease, Chronic Obstructive
Tertiary Care Centers
