title: COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates.
abstract: BACKGROUND
  COPD is the third leading cause of death in the world. Utilizing care bundles during acute COPD exacerbations results in fewer complications and lower costs. Our aim was to construct a COPD exacerbation care bundle and evaluate the effects on patient care.
  
  
  METHODS
  We conducted a prospective analysis of 44 patients admitted with a COPD exacerbation to a single tertiary care facility. Primary outcomes included length of stay, readmission rates, and hospital costs. Secondary outcomes included patient education, pulmonologist follow-up, and timeliness of medication administration. Two cohorts were analyzed: those treated with an electronic COPD care bundle (cases; N=22) versus those treated without the care bundle (controls; N=22).
  
  
  RESULTS
  Mean length of stay (51.2 vs 101.1 hours in controls; P-value =0.001), 30-day readmission rates (9.1% vs 54.4% in controls; P-value =0.001), and 60-day readmission rates (22.7% vs 77% in controls; P-value =0.0003) decreased in the care bundle group. Ninety-day hospital costs had a significant difference in the care bundle group (US$7,652 vs US$19,954 in controls; P-value =0.044). Secondary outcomes included a 100% rate of COPD inhaler teaching (vs 27.3% in controls; P-value <0.001), 59.1% rate of pulmonologist follow-up after discharge (vs 18.2% in controls; P-value =0.005), and a mean reduction in time to steroid administration (7.0 hours; P-value =0.015) seen in the care bundle cases.
  
  
  CONCLUSIONS
  Our significant findings coupled with the recent success of standardized algorithms in managing COPD exacerbations stress the importance of enforcing clinical guidelines that can enhance patient care. We demonstrated improved care for COPD exacerbation patients during hospitalizations, thereby decreasing morbidity and the financial burden hospitals face in regard to this increasingly prevalent disease.
authors.affiliation: Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Raj
authors.initials: R
authors.lastname: Parikh
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Trushil G
authors.initials: TG
authors.lastname: Shah
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Rajive
authors.initials: R
authors.lastname: Tandon
mesh_terms: D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D059039:Standard of Care / Q000592:standards*
keywords: COPD; acute exacerbation of chronic obstructive lung disease; care bundle