Use of a standardized order set in the management of an acute exacerbation of COPD

INTRODUCTION: Acute exacerbations of COPD (AECOPD) are a common cause of hospitalization, morbidity and mortality. Despite the existence of management guidelines for AECOPD, there is variability in care amongst admitting services. Standardized admission orders have been demonstrated to result in consistent care and improved outcomes. OBJECTIVE: Our aim was to compare degree of variability in care among different admitting services at the University of Alberta Hospital (UAH). As a secondary outcome, we hypothesized that the use of a standardized order set (OS) based on current Canadian guidelines would reduce variability in management and improve patient outcomes. METHODS: We performed a retrospective chart review of 160 consecutive admissions for AECOPD to the UAH from September 1, 2012 to February 1, 2013. All patients were admitted to one of the Family Medicine (FM), Internal Medicine (IM) or Pulmonary Medicine (PM) wards. Comparisons in the medical management were made between admission services and in those using the OS versus current clinical practice. RESULTS: 29 patients were admitted to FM, 68 to IM and 63 to PM. Of the FM, IM and PM group, inhaler therapy was appropriate in 48%, 40%, 63.5% and discharge inhalers in 69%, 53% and 63.5% respectively. Outpatient rehabilitation referral was sent in 3%, 0% and 12.5% and smoking cessation counseled in 7%, 6% and 2% respectively. These values increased to 83%, 83%, 25% and 0% in the 12 patients that used the OS respectively. CONCLUSIONS: There is a significant variation in care among the admitting services. Patients in whom the OS had been used had a higher percent of appropriate therapy and therefore future work is directed at increasing OS uptake.