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Respiratory Care BundlesProfessor Thida Win
Lister HospitalThida.win@nhs.net
November 2012 - December 2013 21 NHS Trusts in England and Wales a care bundles-based approach to quality
improvement in the care of patients admitted to hospital with an acute exacerbation of COPD (AECOPD) and Community Acquired Pneumonia (CAP)
BTS (British Thoracic Society)Care Bundle Project
High level data 11,748 patients admitted with AECOPD 14,451 patients admitted with CAP
Patient level data on processes and outcomes of care 3,266 COPD admissions 2,563 CAP admissions
1,438 bundles were used
use of a care bundle was associated with a reduction in 30 day in-patient mortality from CAP from 13.6% to 8.8%.
The presence of an oxygen prescription was also associated with a reduction in length of stay for those with COPD
Benefits
COPD admission bundle with outcomes of care demonstrated a statistically significant reduction in mortality from AECOPD in patients in whom oxygen was prescribed at admission (OR 0.22
95%CI 0.05-0.88) and in patients in whom care was delivered within 4
hours of admission (OR 0.60 95% CI 0.42-0.87)
This is the first time that use of a COPD bundle has been associated with a reduction in in-hospital mortality!
Mortality
COPD Care Bundle (Acronym: DARTS) Diagnosis Assessment (for oxygen) Recognition (of acidosis) Timely medications Specialist review
Care Bundle Components
COPD Discharge Care Bundle (Acronym: TAPSS) Technique (inhalers) Action plan Pulmonary rehabilitation Smoking Cessation Specialist follow-up
Care Bundle Components cont..
Pneumonia Care Bundle (Acronym: COST) Chest x-ray (CXR) Oxygen (assessment) Severity (Scoring) Timely & appropriate treatment
Care Bundle Components cont..
14/15 Trust replied 4 Trusts not using Care Bundles at time of survey,
but 1 was implementing Majority (9) use a COPD discharge-bundle 1 uses admission and Pneumonia bundle (KL) 3 use asthma bundle addition to discharge bundle
(Add/ Ip/South) 1 use pneumonia and admission bundle addition
to discharge bundle (JP) 2 on Respiratory wards, 2 at MAU and 10 at All
EoE Care Bundle Survey
L&D Princess Alexandra (Harlow) Peterborough
Trusts not using Care Bundles
3 Trusts achieved >90% use of discharge bundle Southend West Herts E&N Herts
Success
Help readmissions 25% reduction in readmission (Ipswich) Some found difficult to say specific benefit
due to partial effects- pathway, specialist review, education, staff change over etc
Benefit
CCGs Staffing Support Evidence CQUIN will ensure delivery of care bundle
Barriers to implementation
Care Bundles effective in improving reliability and reducing unwarranted variation in care
Wide implementation of Care Bundles is feasible Evidence suggested CAP, and COPD admission
bundle shows mortality benefit Emergency Oxygen prescribing & timely care
essential components Value of Clinical Specialist Leadership to ensure
success Most EoE Trusts use care bundles, but uncertainty
of their components and outcomes
Conclusions
Recommended