Immediate and early discharge for patients with exacerbations of chronic obstructive pulmonary disease: is there a role in "real life"?

Abstract

An exacerbation of chronic obstructive pulmonary disease (COPD) is the most common respiratory condition necessitating admission to hospital. Many of these are relatively mild in nature and as a consequence, there is increasing interest in immediate and early discharge of patients with nonsevere exacerbations. Following initial assessment, "hospital at home" or "assisted discharge" schemes enable suitable patients with COPD to be discharged into the community earlier than normally anticipated. The putative implication is that substantial financial savings can be made in addition to increasing the availability of in-patient beds, without compromising patient care or satisfaction. We highlight the current literature which has evaluated the role of hospital at home and assisted discharge schemes and discuss our own "real life" service operating in a large teaching hospital in Scotland.

Figure 1

Algorithm describing proposed protocol for entering patients into assisted hospital discharge. Abbreviation: COPD, chronic obstructive pulmonary disease.