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Increasing use of the COPD Discharge Bundle in acute trusts

The British Thoracic Society (BTS) has developed a Chronic Obstructive Pulmonary Disease (COPD) discharge care bundle that aims to improve care, help patients manage their condition at home, and reduce readmissions. As one of 15 patient safety collaboratives in England, UCLPartners has supported nine trusts to adopt the care bundle for patients admitted to hospital with COPD.

Challenge

In the first quarter of 2019/2020, National Asthma and COPD clinical audit (NACAP) data showed that just 11% of patients in UCLPartners’ 23 partner trusts were receiving all elements of the COPD discharge bundle they were eligible for.

This low update of all elements of the bundle was of concern because, as Professor Mike Roberts, Managing Director UCLPartners and a respiratory physician explains: “We know that patients who are hospitalised for an exacerbation often enter a cycle of recurrent admissions and deteriorating health. Intervening early and giving patients the right treatments, information and education is vital in trying to reduce admissions.”

What we did

UCLPartners set up a network with nine acute trusts in the region to increase use of the care bundle, to improve care for patients admitted to hospital.

An initial design meeting was set up and participating teams agreed to increase the number of patients receiving a complete discharge bundle and to improve case ascertainment (data capture). Teams identified challenges relating to documenting care, coding and data input, together with barriers to completing all elements of the discharge bundle.

The network then facilitated discussions to enable teams to share best practice. Regular meetings and teleconferences were organised, with teams coached in quality improvement skills to support local work. Two sessions brought both the clinical and coding team members together to understand the challenges from both perspectives. Each hospital conducted a ‘mini-audit’ of five patients, involving both coding staff and a clinician to support understanding of their internal processes. Examples of a ‘good’ and ‘bad’ discharge summary were also discussed. This resulted in teams working to improve the quality of discharge summaries, initiating regular meetings with coding staff and engaging additional colleagues to undertake elements of the Discharge Bundle.

The patient was at the centre of all we did. We were able to share ideas and create new ones on how to improve implementation of the bundle and get the diagnosis right.

Respiratory Consultant Dr Swapna Mandal, Clinical Lead UCLPartners COPD discharge bundle collaborative

Impact/outcomes

Analysis of data reported through the NACAP for the nine participating trusts between April 2019 and March 2020 showed a 152% increase – from 13% to 33% – in patients receiving every element of the bundle they were eligible for. This is important as the evidence shows that the bundle has the most benefit for patients when all elements are completed.

Next steps

Over 2020/21, the collaborative will continue to work together to adapt and improve patient care and processes amid the COVID-19 pandemic to ensure safer and better-quality care for COPD patients.