title: Does the introduction of a COPD pro-forma improve the standards of care delivered by junior doctors in the emergency department.
abstract: OBJECTIVE
  To determine if pro-forma based management improves standards of care delivered by junior doctors in chronic obstructive pulmonary disease (COPD) patients in the Emergency Department (ED).
  
  
  BACKGROUND
  National COPD audits have found large variations in ED standards of care compared to guidelines. They concluded that the publication of guidelines itself does not translate to an improvement in care.
  
  
  METHODS
  A pro-forma based on the British Thoracic Society Guidelines on COPD, 1997, NICE Guidelines CG12, 2004 and Non Invasive Ventilation (NIV), 2002 was devised and implemented following targeted education. Data were collected pre and post pro-forma implementation and analysed. The primary end point was categorisation of respiratory failure as it was felt that this concept was fundamental in COPD management. Secondary endpoints included the administration of controlled oxygen, repeat blood gases and appropriate referral for NIV.
  
  
  RESULTS
  There were a total of 55 patients in each group. The correct categorisation of respiratory failure improved significantly from 4% in the pre- compared to 89% (p < 0.0001) in the post-intervention group. Similarly the administration of controlled oxygen (47% compared to 92%, p < 0.0001), repeat arterial blood gases (50% compared to 83%, p = 0.0098), and appropriate referral for NIV (33% compared to 100%, p = 0.0023) showed significant improvement after the pro-forma was introduced.
  
  
  CONCLUSIONS
  Pro-forma aided management significantly improves the standards of care in COPD patients in the ED.
authors.affiliation: Newcastle General Hospital, Newcastle Upon Tyne, UK. bas.sen@nuth.nhs.uk
authors.forename: Basav
authors.initials: B
authors.lastname: Sen
authors.forename: Malcolm
authors.initials: M
authors.lastname: Woollard
authors.forename: Nicola L
authors.initials: NL
authors.lastname: Desira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003695:Delivery of Health Care / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000517:prevention & control; D012189:Retrospective Studies