Abstract
Objective: To evaluate the quality of care of patients
with acute exacerbation of COPD in our tertiary care
hospital and evaluate the change in practice after
educational program and recommendations.
Methodology: An initial audit from 01/12/2013 to
31/11/2014 was carried out. Standard of care was
determined with inpatient mortality, length of hospital
stay, accuracy of initial controlled oxygen
prescription, history and clinical assessment at
admission, adherence of post graduate trainees to
GOLD guidelines and discharge recommendations. A
re-audit was performed in July 2015 with analysis of 6
months data.
Results: A total of the 121 files were included in first
audit. Though the pattern in mortality remained the
same, a significant reduction in median length of
hospital stay from 11 to 7 to 8 days (p = 0.003) was
observed. A significant improvement was seen in
documentation of biomass exposure, renal failure,
Anthonisen criteria, Performance status, systematic
steroids, Anticoagulation (heparin), PEFR before
discharge, Inhaler technique, Smoking cessation
advice, vaccination advice, outpatient follow-up and
oral steroid in re-audit phase of the study. Consistent
practice was observed with regards to good inpatient
prescription of oxygen therapy, systemic steroids and
antibiotics.
Conclusion: Improvement in quality of care for
AECOPD can be achieved with continuous education
and monitoring of postgraduate doctors, a more
systemic approach to patients, adherence to standard
guidelines and intermittent audits.
Keywords: Chronic obstructive pulmonary disease,
acute exacerbation of COPD, inpatient care.
