Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100968563 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2466 (Electronic) Linking ISSN: 14712466 NLM ISO Abbreviation: BMC Pulm Med Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001]-
    • Subject Terms:
      Pulmonary Disease, Chronic Obstructive*/diagnosis ; Pulmonary Disease, Chronic Obstructive*/therapy; Length of Stay/*statistics & numerical data ; Medical Order Entry Systems/*standards ; Patient Admission/*standards ; Patient Readmission/*statistics & numerical data; Canada ; Decision Support Systems, Management ; Evidence-Based Practice/methods ; Humans ; Quality Improvement ; Symptom Flare Up ; Tertiary Care Centers/organization & administration
    • 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.
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    • Contributed Indexing:
      Keywords: Chronic obstructive pulmonary disease; Clinical decision support; Length of stay; Quality improvement
    • Publication Date:
      Date Created: 20180531 Date Completed: 20190403 Latest Revision: 20190403
    • Publication Date:
      20240829
    • Accession Number:
      PMC5975274
    • Accession Number:
      10.1186/s12890-018-0657-x
    • Accession Number:
      29843772