Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease
AuthorPendharkar, Sachin R.
Ospina, Maria B.
Gadotti, D. A.
Graham, Jim Allen
Faris, Peter D.
Leigh, Richard A.
Mody, Christopher H.
Strickland, Michael K.
SubjectLength of stay
Clinical decision support
Chronic obstructive pulmonary disease
MetadataShow full item record
AbstractBackground: 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
GrantingagencyAlberta Health Services - Research Grant
SponsorshipSponsored by the Open Access Authors Fund
DepartmentCommunity Health Sciences
FacultyCumming School of Medicine
InstitutionUniversity of Calgary
PublisherBMC Pulmonary Medicine
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