title: Audit of acute exacerbations of chronic obstructive pulmonary disease at Waitemata District Health Board, New Zealand.
abstract: OBJECTIVE
  To examine management and outcome of patients admitted to Waitemata District Health Board (WDHB) with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and determine performance according to evidence-based guidelines.
  
  
  METHODS
  Retrospective chart review of all patients admitted to WDHB hospitals with primary diagnosis of AECOPD during May and October 2010. 195 admissions (156 patients) were audited.
  
  
  RESULTS
  Patients comprised 72 females and 84 males; mean age 73.1 years. 96% were ever-smokers. 10% of patients had BMI <18 kg/m2 and 40% of these received no dietician input. Spirometry was recorded in 72% within the previous 5 years. Chest X-ray was performed in 96% in the first 24 hours and 33% had arterial blood gas (ABG) performed. Twenty-three patients (29%) had acute respiratory acidosis. Continuous positive airways pressure (CPAP) was used in 11 but none received non-invasive ventilation (NIV). Systemic corticosteroids and antibiotics were prescribed to 87% and 84% respectively. Ten percent of patients were referred for pulmonary rehabilitation (PR). Overall 90-day mortality was 6.7% with 3.1% inpatient mortality. Mean length of stay was 5 days. 90-day re-admission rate was 44%.
  
  
  CONCLUSIONS
  Areas of good adherence to best practice guidelines. Room for improvement in use of NIV, ABG and spirometry measurement, and PR referral.
authors.affiliation: Freemasons' Department of Geriatric Medicine, University of Auckland, PO Box 93 503, Takapuna, Auckland, New Zealand. cheryl.johnson@waitematadhb.govt.nz.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Johnson
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Connolly
authors.forename: Shirley
authors.initials: S
authors.lastname: Clover
authors.forename: Laura
authors.initials: L
authors.lastname: Campbell
authors.forename: Robyn
authors.initials: R
authors.lastname: Goonan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Salmon
authors.forename: Michelle
authors.initials: M
authors.lastname: Hopley
authors.forename: Martin
authors.initials: M
authors.lastname: Phillips
authors.forename: Jaideep
authors.initials: J
authors.lastname: Sood
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome