Audit of acute admissions of COPD: standards of care and management in thehospital setting

Despite publication of several management guidelines for COPD, relatively l ittle is known about standards of care in clinical practice. Data mere collected on the management of 1400 cases of acute admission with Chronic Obstructive Pulmonary Disease in 38 UK hospitals to compare clinic al practice against the recommended British Thoracic Society standards. Var iation in the process of care between the different centres was analysed an d a comparison of the management by respiratory specialists and nonrespirat ory specialists made. There were large variations between centres for many of the variables studi ed. A forced expiratory volume in one second measurement was found in only 53% of cases. Of the investigations recommended in the acute management art erial blood gases mere performed in 79% (interhospital range 40-100%) of ad missions and oxygen was formally prescribed in only 64% (range 9-94%). Of t hose cases with acidosis and hypercapnia 35% had no further blood gas analy sis and only 13% received ventilatory support. Long-term management was als o deficient with 246 cases known to be severely hypoxic on admission yet tw o-thirds had no confirmation that oxygen levels had returned to levels abov e the requirements for long-term oxygen therapy. Only 30% of current smoker s had cessation advice documented. To conclude, the median standards of care observed fell below those recomme nded by the guidelines, The lowest levels of performance were for patients not under the respiratory specialists, but specialists also have room for i mprovement. The substantial variation in the process of care between hospit als is strong evidence that it is possible for other centres with poorer pe rformance to improve their levels of care.