Hospital readmissions for COPD in England are rising, audit showsBMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j557 (Published 01 February 2017) Cite this as: BMJ 2017;356:j557
The number of hospital readmissions among people with chronic obstructive pulmonary disease (COPD) rose by almost a third from 2008 to 2014, an analysis has shown.1
The latest National COPD Audit Programme report from the Royal College of Physicians showed that, in 2014, 43% of patients in England who were admitted for hospital treatment of COPD were readmitted at least once in the three months after discharge. This represents a considerable increase from the 33% readmission rate reported in the last audit in 2008.2
The college said that the current system was failing COPD patients and called for improvements to tackle ineffective discharge processes, poor coordination between primary and secondary care services, and inadequate provision of community and social care.
It added that COPD was the single most common cause of hospital readmission in 2014. Over 50% of readmissions were in older people with multiple health conditions, many of whom had also been admitted to hospital in the months before the audit.
Some improvements in the safety and efficiency of COPD care were seen over time, the authors noted, as inpatient mortality had decreased from 7.9% in 2003 to 4.3% in 2014 and fewer patients were dying after discharge from hospital. The average hospital stay for acute exacerbation of COPD also fell markedly from 2003 to 2014, from six days to four days.
But the report highlighted the potential for further improvements if certain measures were implemented, including early identification of patients at risk of deterioration and careful assessment of those with multiple healthcare needs and conditions. It also called for improved discharge planning, particularly among vulnerable and frail patients, and for the development of integrated approaches to COPD care.
Led by the Royal College of Physicians, the report was commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit and Patient Outcomes Programme.
Robert Stone, consultant respiratory physician at Taunton and Somerset NHS Foundation Trust and clinical lead for the National COPD Audit Programme, said, “There have been some very encouraging improvements in efficiency and patient outcomes. However, it is clear from the data in this report that significant improvements must be made in order to support the needs of this complex and fragile patient group.”
He added, “Emphasis must be placed on the development of an integrated care system that focuses on the needs and management of older patients and those with more than one health condition.
“It is vital that primary, secondary, and social care services work better together to support people suffering with COPD, placing them firmly at the centre of their own care.”
Carol Stonham, primary care respiratory nurse specialist in Gloucestershire and nurse lead for the Primary Care Respiratory Society UK, said, “There is so much for people with COPD to gain if we work, as this report suggests, in an integrated way across traditional boundaries.”