REDUCING LENGTH OF STAY FOR PATIENTS HOSPITALIZED WITH EXACERBATION OF COPD BY USING A PRACTICE GUIDELINE

Clinical practice guidelines have been promoted as an effective way of reducing costs while maintaining quality care. Objective: To study a practice guideline to shorten length of stay for patients hospitalized with exacerbation of COPD. Methods: We retrospectively studied a prac tice guideline to identify patients who were at low risk of complicati ons from their exacerbation of COPD and hence potentially suitable for early hospital discharge. We then prospectively studied the practice guideline using an alternate month intervention and control time serie s over a period of 12 months. Results: The practice guideline was retr ospectively studied in 250 consecutive patients hospitalized with exac erbation of COPD. Of the 250 patients, 237 patients (94.8%) were class ified as low risk after 72 h of hospitalization and were potentially s uitable for discharge. In the prospective study, few patients (24 of 1 24 or 19%) were identified for implementation of the guideline. Howeve r, in those patients who were identified, length of stay was not stati stically different. The data also showed that length of stay for both intervention and control groups had shortened over this time. Conclusi on: Certain practice guidelines may appear efficacious in studies but may actually lack effectiveness when applied in clinical settings and may even increase costs. We demonstrated the importance of prospective ly evaluating clinical practice guidelines before recommending them fo r widespread implementation.