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COPD care improving but better access to specialists still needed

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Care for patients with chronic obstructive pulmonary disease has improved over the past six years, but is still not good enough, according to a major audit.

Many patients with the most severe illness are being well managed and progress had been made in speeding up discharge. But particular concerns continue about service variability and access to specialist care.

The results of the national COPD clinical audit report – COPD: who cares matters – were published today and draw comparisons with a similar piece of research last carried out in 2008.

Led by the Royal College of Physicians, the audit looked at the care of 13,414 patients admitted with a COPD exacerbation at 142 trusts in England and six health boards in Wales between 1 February and 31 April 2014.

The audit report said it was encouraging that mortality in hospital has reduced from 7.8% in 2008 to 4.3% in 2014 – though the reason is unclear – and the median length of hospital stay has reduced from five to four days.

There has also been a large rise in the number of patients able to leave hospital early due to early/supported discharge schemes – from 18% in 2008 to 40% in 2014.

Overall, management of the sickest patients has generally improved, said the report. However, the audit found standards of care differed greatly across England and Wales.

Although patients were seen and treated promptly on admission, there were often significant delays in getting a specialist opinion from a member of the respiratory team to patients needing to stay in hospital.

“There needs to be additional investment to ensure that the appropriate level of specialist nursing support is commissioned locally”

Matthew Hodges

Many patients were managed on non-respiratory wards. Importantly, it said  45% of patients were discharged within three days, many of whom had no contact with respiratory specialists, and one in five patients were not seen by a respiratory expert at all during their stay.

Weekend care was also an issue, with far fewer patients being discharged or seen by the respiratory team within 24 hours of admission, compared to other days.

There was also room for improvement in five “key clinical areas”, said the report.

It noted that correct oxygen prescribing was absent in the care of 32% of patients, only 58% of patients who smoked had evidence of smoking cessation advice being given and spirometry was available in only 46% of cases.

In addition, 44% of patients had no assessment made for pulmonary rehabilitation at the point of discharge.

All of these “necessary processes” were more likely to have been delivered when patients were seen by a member of the respiratory specialist team, it noted.

Matthew Hodson, COPD nurse consultant and vice chair of the Association of Respiratory Nurse Specialists, said: “The report highlights that improvements in care have been made but additional process and systems need to be addressed.

“The respiratory clinical nurse specialists are in a unique position to support this and have a fundamental role in the management and support of patients while in hospital and the community,” he said.

“However, there needs to be additional investment to ensure that the appropriate level of specialist nursing support is commissioned locally, reducing variation and improving care further for people living with COPD,” he added.


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