When do patients with chronic obstructive lung disease need hospital admission? Reflections based on a VA experience.
Over a two-year period, the management of patients with chronic obstructive lung disease was observed in the walk-in clinic of a Veterans Administration Medical Center. Of 794 visits, 279 (35%) resulted in immediate hospitalization. Of 515 patients sent home, 229 (44%) relapsed, and of these, 165 (72%) eventually required admission. The clinical and laboratory data routinely obtained, including arterial blood gas values in 69% of the visits, could not distinguish the inappropriate discharges unless acidosis or severe hypoxemia was present. About 10% of the patients accounted for 30% of the admissions. Severity of disease, especially the development of cor pulmonale, accounted only partially for high demand by a subset of patients. Psychosocial factors and inadequacy of facilities for continuing home care play an essential, though poorly defined, role in precipitating hospital admissions.
D000328:Adult; D000368:Aged; D001130:Arizona; D002245:Carbon Dioxide / Q000097:blood; D003657:Decision Making; D005069:Evaluation Studies as Topic; D006787:Hospitals, Veterans; D006801:Humans; D007902:Length of Stay; D008173:Lung Diseases, Obstructive / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D010100:Oxygen / Q000097:blood; D010343:Patient Admission; D012008:Recurrence; D013997:Time Factors
D002245:Carbon Dioxide; D010100:Oxygen