Gaps in the Inpatient Management of Chronic Obstructive Pulmonary Disease Exacerbation and Impact of An Evidence-Based Order Set. Issue 3 (2015)

• Record Type: Journal Article
• Authors: Kitchlu, Abhijat; Abdelshaheed, Tamer; Tullis, Elizabeth; Gupta, Samir
• Is Part Of: Canadian respiratory journal. Volume 22:Issue 3(2015)
• Page Start: 157
• Page End: 162
• Publication Date: 2015
• Subjects: Chronic obstructive pulmonary disease -- Knowledge translation -- Length of stay -- Medical order entry systems -- Quality improvement; Respiratory organs -- Diseases -- Periodicals; Respiration -- Canada -- Periodicals; Respiration; Respiratory organs -- Diseases; Canada; Respiratory Tract Diseases -- Periodicals; Periodicals; Periodicals; 616.2
• DOI: 10.1155/2015/587026
• Languages: English
• ISSNs: 1198-2241

Abstract

Abstract : BACKGROUND: Evidence-based, guideline-recommended practices improve multiple outcomes in patients admitted with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but are incompletely implemented in actual practice. Admission order sets with evidence-based diagnostic and therapeutic guidance have enabled quality improvement and guideline implementation in other conditions. OBJECTIVE: To characterize the magnitude of care gaps and the effect of order sets on quality of care in patients with AECOPD. METHODS: The authors prospectively designed a standardized chart review protocol to document process of care and health care utilization before and after implementation of AECOPD order sets at an academic hospital in Toronto, Ontario. RESULTS: A total of 243 total AECOPD admissions and multiple important care gaps were identified. There were 74 admissions in the pre-order set period (January to June 2009) and 169 in the order set period (October 2009 to September 2010). The order set was used in 78 of 169 (46.2%) admissions. In the order set period, we observed improvements in respiratory therapy educational referrals (five of 74 [6.8%] versus 48 of 169 [28.4%]; P<0.01); venous thromboembolism prophylaxis prescriptions (when indicated) (15 of 68 [22.1%] versus 100 of 134 [74.6%]; P<0.01); systemic steroid prescriptions (55 of 74 (74.3%) versus 151 of 169 [89.4%]; P<0.01]); and appropriate antibiotic prescriptions (nine of 24 [37.5%] versus 61 of 88 [69.3%]; P<0.01). The mean (± SD) length of stay also decreased from 6.5±7.7 days before order sets to 4.1±5.0 days with order sets (P=0.017). CONCLUSIONS: Care gaps in inpatient AECOPD management were large and evidence-based order sets may improve guideline adherence at the point of care. Randomized trials including patient outcomes are required to further evaluate this knowledge translation intervention.