Early supported discharge at exacerbation of COPD: safe and cost effective for some
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Specialist Registrar, Broomfield Hospital, Essex, UK; samanthacooper@doctors.org.uk
Ram FSF, Wedzicha JA, Wright J, et al. Hospital at home for patients with acute exacerbations of chronic obstructive pulmonary disease: systematic review of evidence. BMJ 2004;329:315–8.[Abstract/Free Full Text]
This systematic review of seven randomised controlled trials (n = 754 patients) compared "hospital at home" with inpatient management of acute exacerbations of COPD. Carefully selected patients were randomised within 72 hours of presentation to hospital. The combined results show that patients with an acute exacerbation of COPD can be safely and successfully treated at home with support from visiting respiratory nurses and a multidisciplinary team. Readmission and mortality data showed no difference between "hospital at home" and inpatient care (relative risks 0.89 (95% CI 0.72 to 1.12) and 0.61 (95% CI 0.36 to 1.05), respectively). While not an option for all patients (only one in four met the strict inclusion criteria), there were substantial savings in terms of direct financial cost and the number of hospital bed days freed. It also increases patient choice.
It is concluded that, with adequate support and sufficient medication supplies, early discharge of selected patients with exacerbations of COPD is safe and leads to considerable financial savings.(S Cooper)
Ram FSF, Wedzicha JA, Wright J, et al. Hospital at home for patients with acute exacerbations of chronic obstructive pulmonary disease: systematic review of evidence. BMJ 2004;329:315–8.[Abstract/Free Full Text]
This systematic review of seven randomised controlled trials (n = 754 patients) compared "hospital at home" with inpatient management of acute exacerbations of COPD. Carefully selected patients were randomised within 72 hours of presentation to hospital. The combined results show that patients with an acute exacerbation of COPD can be safely and successfully treated at home with support from visiting respiratory nurses and a multidisciplinary team. Readmission and mortality data showed no difference between "hospital at home" and inpatient care (relative risks 0.89 (95% CI 0.72 to 1.12) and 0.61 (95% CI 0.36 to 1.05), respectively). While not an option for all patients (only one in four met the strict inclusion criteria), there were substantial savings in terms of direct financial cost and the number of hospital bed days freed. It also increases patient choice.
It is concluded that, with adequate support and sufficient medication supplies, early discharge of selected patients with exacerbations of COPD is safe and leads to considerable financial savings.(S Cooper)