ABSTRACT
AIM: 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%. CONCLUSION: Areas of good adherence to best practice guidelines. Room for improvement in use of NIV, ABG and spirometry measurement, and PR referral.
