[Nurse-supported discharge of patients with exacerbation of chronic obstructive pulmonary disease]

Abstract

Background: The study was conducted to investigate the safety of "hospital at home" versus hospital care.

Materials and methods: It was a prospective randomised controlled trial. Patients with an exacerbation of chronic obstructive pulmonary disease (COPD) were included and randomised to supported discharge (n = 22) or to conventional in-patient care (n = 22). Outcome measures were readmissions, complications, mortality within 60 days of initial admission.

Results: 390 patients (COPD) were admitted and 44 patients (12%) were included in the study. In the home treatment period 2 patients (9%) were readmitted. One patient (4.5%) died 2 weeks after discharge from the home treatment. In the follow-up period 3 patients in the home treated group were readmitted 7 times (31.8%), and 7 patients in the conventional in-patient group were readmitted 9 times (40.9%). There were 14 complications (63.6%) in the home treated group and 15 complications (68.3%) in the conventional in-patient group. The length of hospital stays in the supported discharged group were shorter (1.3 (std = 0.5) versus 3.7 (std = 2.8) days, p = 0.002). After discharge a respiratory nurse visited supported discharged patients at home during 5.1 days (min. 2 days, max. 13 days) with 2.6 visits per patient (min. 1, max 6 visits).

Conclusion: This study shows that home supported discharge is a well tolerated, safe and economic alternative to hospital admission for a proportion of patients referred to hospital for admission for COPD.