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. 2018 Oct 14;5(1):e000334.
doi: 10.1136/bmjresp-2018-000334. eCollection 2018.

Specialist emergency care and COPD outcomes

Nicholas David Lane  1   2 , Karen Brewin  1 , Tom Murray Hartley  1   2 , William Keith Gray  1 , Mark Burgess  1 , John Steer  1   2 , Stephen C Bourke  1   2
Affiliations

Specialist emergency care and COPD outcomes

Nicholas David Lane et al. BMJ Open Respir Res. .

Abstract

Introduction: In exacerbation of chronic obstructive pulmonary disease (ECOPD) requiring hospitalisation greater access to respiratory specialists improves outcome, but is not consistently delivered. The UK National Confidential Enquiry into Patient Outcome and Death 2015 enquiry showed over 25% of patients receiving acute non-invasive ventilation (NIV) for ECOPD died in hospital. On 16 June 2015 the Northumbria Specialist Emergency Care Hospital (NSECH) opened, introducing 24/7 specialty consultant on-call, direct admission from the emergency department to specialty wards and 7-day consultant review. A Respiratory Support Unit opened for patients requiring NIV. Before NSECH the NIV service included mandated training and competency assessment, 24/7 single point of access, initiation of ventilation in the emergency department, a door-to-mask time target, early titration of ventilation pressures and structured weaning. Pneumonia or hypercapnic coma complicating ECOPD have never been considered contraindications to NIV. After NSECH staff-patient ratios increased, the NIV pathway was streamlined and structured daily multidisciplinary review introduced. We compared our outcomes with historical and national data.

Methods: Patients hospitalised with ECOPD between 1 January 2013 and 31 December 2016 were identified from coding, with ventilation status and radiological consolidation confirmed from records. Age, gender, admission from nursing home, consolidation, revised Charlson Index, key comorbidities, length of stay, and inpatient and 30-day mortality were captured. Outcomes pre-NSECH and post-NSECH opening were compared and independent predictors of survival identified via logistic regression.

Results: There were 6291 cases. 24/7 specialist emergency care was a strong independent predictor of lower mortality. Length of stay reduced by 1 day, but 90-day readmission rose in both ventilated and non-ventilated patients.

Conclusion: Provision of 24/7 respiratory specialist emergency care improved ECOPD survival and shortened length of stay for both non-ventilated and ventilated patients. The potential implications in respect to service design and provision nationally are substantial and challenging.

Keywords: COPD epidemiology; COPD exacerbations; assisted ventilation; emphysema; non-invasive ventilation.

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Conflict of interest statement

Competing interests: SCB, JS, NDL and TMH are currently undertaking a 10-centre NIV Outcomes trial, funded in part by Philips Respironics and Pfizer Open Air (outside the submitted work). SCB reports grants from the National Institute of Health Research, Philips Respironics and Pfizer Open Air, personal fees from ResMed, Pfizer and from AstraZeneca, and non-financial support from GSK and Boehringer Ingelheim outside the submitted work. NDL and TMH are employed and funded by Northumbria Healthcare NHS Foundation Trust Research Fellowship programme.

Figures

Figure 1
Figure 1
Timeline of changes to the Northumbria non-invasive ventilation pathway between 2003 and 2017. COPD, chronic obstructive pulmonary disease; NIV, non-invasive ventilation; NSECH, Northumbria Specialist Emergency Care Hospital; RSU, Respiratory Support Unit.
Figure 2
Figure 2
Variable life adjusted display (VLAD chart) showing observed versus expected mortability with cumulative lives lost below the x-axis and cumulative lives saved above the x-axis. NSECH, Northumbria Specialist Emergency Care Hospital.
See this image and copyright information in PMC

References

    1. Department of Health. Department of Health Medical Directorate Consultation on a strategy for services for Chronic Obstructive Pulmonary Disease (COPD) in England, 2010. - PubMed
    1. Shahab L, Jarvis MJ, Britton J, et al. . Prevalence, diagnosis and relation to tobacco dependence of chronic obstructive pulmonary disease in a nationally representative population sample. Thorax 2006;61:1043–7. 10.1136/thx.2006.064410 - DOI - PMC - PubMed
    1. Global Iniative for Chronic Obstructive Lung Disease (GOLD) From the Global Strategy for the Diagnosis, Management and prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018, 2018.
    1. Department of Health. Department of Health Medical Directorate An Outcomes Strategy for Chronic Obstructive Pulmonary Disease (COPD) and Asthma, 2011.
    1. Department of Health, 2012. An Outcomes Strategy for COPD and Asthma: NHS Companion Document. Departmentof Health Medical Directorate. Available from: www.dh.gov.uk/publications2012

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