Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease
Date
2018-05-30
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Pulmonary Medicine
Abstract
Background: Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary
disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening
quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could
improve quality and reduce length of stay.
Methods: The order set was designed by a provincial COPD working group and implemented voluntarily among three
physician groups in a Canadian tertiary-care teaching hospital. The primary outcome was length of stay for patients
admitted during order set implementation period, compared to the previous 12 months. Secondary outcomes
included length of stay of patients admitted with and without order set after implementation, all-cause readmissions,
and emergency department visits.
Results: There were 556 admissions prior to and 857 admissions after order set implementation, for which the order
set was used in 47%. There was no difference in overall length of stay after implementation (median 6.37 days (95%
confidence interval 5.94, 6.81) pre-implementation vs. 6.02 days (95% confidence interval 5.59, 6.46) post-implementation,
p = 0.26). In the post-implementation period, order set use was associated with a 1.15-day reduction in length of stay
(95% confidence interval − 0.5, − 1.81, p = 0.001) compared to patients admitted without the order set. There was no
difference in readmissions.
Conclusions: Use of a computerized guidelines-based admission order set for COPD exacerbations reduced hospital
length of stay without increasing readmissions. Interventions to increase order set use could lead to greater
improvements in length of stay and quality of care.
Keywords: Length of stay, Clinical decision support, Chronic obstructive pulmonary disease, Quality
improvement
Description
Keywords
Length of stay, Clinical decision support, Chronic obstructive pulmonary disease, Quality improvement
Citation
Pendharkar, S. R., Ospina, M. B., Southern, D. A., Hirani, N., Graham, J., Faris, P., … Stickland, M. K. (2018). Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease. BMC Pulmonary Medicine, 18, 93. http://doi.org/10.1186/s12890-018-0657-x