Emergency department management of exacerbation of chronic obstructive pulmonary disease: audit of compliance with evidence-based guidelines.
BACKGROUND
Emergency departments (ED) play a key role in management of exacerbation of chronic obstructive airways disease (COPD). Current guidelines for management of exacerbation of COPD showed highest levels of evidence (Level A and B) were related to use of medications and non-invasive positive pressure ventilation (NIPPV).


OBJECTIVE
The aim of this study was to examine compliance with high level evidence for management of exacerbation of COPD during the first 4 h of ED care.


METHODS
A retrospective medical record audit was conducted at four public and one private ED in Melbourne, Australia. Participants were adult patients with COPD presenting to the ED with a primary complaint of shortness of breath from July 2006 to July 2007. Outcome measures were compliance with evidence-based recommendations regarding use of bronchodilators, methylxanthines, steroids and NIPPV.


RESULTS
Of 273 patients in this study, 72.4% received short-acting beta-agonist bronchodilators, 37.8% received an inhaled short-acting anticholinergic medication and 56.6% received systemic steroid therapy. NIPPV was used in 21 patients, 15 of whom had documentation of acidosis and/or hypercapnia).


CONCLUSIONS
There was variation in the use of high level evidence for the ED management of exacerbation of COPD. The highest rate of compliance was non-use of methylxanthines and the greatest deficit was poor compliance with evidence related to NIPPV. There was also scope for improvement in the use of bronchodilators and systemic steroids.
Considine
J
J
School of Nursing, Deakin University-Northern Health Clinical Partnership, Melbourne, Victoria, Australia. julie.considine@deakin.edu.au
Botti
M
M
Thomas
S
S
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006753:Hospital Records; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D012494:Sampling Studies; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists