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MAU Chronic Obstructive Pulmonary Disorder (COPD) Pathway at Coffs Harbour: from zero to hero Dr Christiaan Mostert Medical Assessment Unit Director Coffs Harbour Health Campus Medical Assessment Unit Forum 27 October 2017
Good Morning !
Coffs Harbour
The Story Story line:
MAU’s journey in addressing readmissions in patients that develop COPD exacerbations…
Not only reducing readmissions,
but utilizing the potential of a full team to make a meaningful contribution to the patient’s life …
MAU, Coffs Harbour, COPD Pathway: from Zero to Hero From … a certain point Zero … starting afresh To … The journey Hero ? Did we achieve something meaningful
From … A starting point …
Summary Readmissions in 2015 A large proportion of readmissions were predictable but unavoidable.
• Vast majority of gastroenterology readmissions were made up of patients with chronic liver disease requiring recurrent ascetic taps.
• All of the haematology/oncology readmissions were complex patients with metastatic disease requiring multiple admissions to optimise treatment of disease and management of symptoms.
However, it is noted that a majority of patients directly discharged from MAU and then readmitted were exacerbations of COPD/Pneumonia.
• It is suggested that a formal protocol and treatment regimen be developed for management of exacerbations of COPD.
COPD/ Pneumonia
31%
Haem/Onc 14% Gastro
23%
Cardio/HTN 20%
Other 12%
MAU Readmissions
COPD/Pneumonia
Haem/Onc
Gastro
Cardio/HTN
Other
COPD/ Pneumonia
24%
Haem/Onc 22%
Gastro 22%
Cardio/HTN 19%
Other 13%
Total Readmissions
COPD/Pneumonia
Haem/Onc
Gastro
Cardio/HTN
Other
To ….
Audit of readmissions
The Task at hand At risk group – readmission and brittle patient
population At this point we now know the scope of the problem
and what these patients look like once admitted to the MAU
Ready to start and develop the MAU COPD pathway All the individuals of the Team with their various
expertise
Consultation: resources for input …
Sources of Input International level : GOLD (Global initiative for
Obstructive Lung Disease) National Guidelines -> COPD Action Plan Recent COPD specific literature Locally we had the patient population identified and
described MAU team input : Allied Health , Nursing & Medical
Staff
Measuring it …. Was it worth it ?
Results 41 patients were enrolled in the audit.
A total of 7 readmissions occurred within 28 days of discharge.
3 of these were due to Exacerbation of COPD (7.3%).
Another dataset to look at … Furthermore comparing it to the readmission rates in
Australia…
NSW (13%) for COPD exacerbation patients with another COPD exacerbation,
the audit compares favourably (7.3%) from an observational point of view
Bureau of Health Information. Chronic Disease Care: Another piece of the picture.
Sydney (NSW); 2012 p. 16-18.
Significance Statistical Clinical Personal
Hero ?
MAU COPD Pathway Standard of care for CHHC MAU Currently utilized on the Medical ward
Meaningful Change
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