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Practices urged to help cut COPD readmissions

Hospital readmissions for deteriorating COPD are on the rise and GP practice teams should do more to help prevent this happening, a Royal College of Physicians report has concluded.

The College’s national COPD audit in secondary care found that during 2014, 43% of people admitted for treatment of COPD were readmitted at least once in the three months after discharge – up from 33% in 2008.

Over half of readmissions were among older people with multiple health conditions, and many had also been admitted to hospital in the months prior to the audit.

The report authors called for primary care teams to follow-up every patient soon after discharge, and to identify COPD patients at risk of deterioration, as well as for hospitals to do better discharge planning.

The authors recommended ‘early review of every discharged case by a suitable primary care team member, to identify issues that may place the patient at increased risk of readmission and to ensure high value interventions have been addressed’.

And they said ’primary care teams should ‘devote resource to identifying, reviewing and enhancing the management of those COPD patients on their lists who are deemed at particular risk of hospital admission’.

Carol Stonham, a respiratory nurse specialist in Gloucestershire and nurse lead for the Primary Care Respiratory Society, said: ‘We need to share what we know to identify the most high risk patients; to utilise the passion and knowledge of respiratory specialists in secondary and community care to enhance the offer to these patients who manage their illness in the community.

‘We need to work with social care to enable patients to get home more quickly with the right support. We have to think beyond the old divides if care is to be effective and sustainable for patients with COPD.’

National COPD Audit Programme: secondary care workstream - Third report


Readers' comments (6)

  • 'We have to think beyond the old divides if care is to be effective and sustainable for patients with COPD.'
    'We have to dump any remaining bits of work on GPs if I'm to keep my funding to swan around seeing my favorite patients with COPD'

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  • Dear Royal College of Physicians
    What is the view like from your Ivory Towers?
    From where I'm standing, at ground level, you look and sound like a bunch of completely useless braying donkeys.

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  • "Many had been admitted previously in the months before the new admission".

    Might a contributory factor be that your RCP members discharge patients before they are fixed?

    Round my way they are discharged before assessment completed, and when we protest, a local physician told me he "was not a diagnostician". Oh, no, Prof Coughinwheezer, perish the thought...

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  • "We have to think beyond the old divides if care is to be effective"

    In this case I look forward to hospital consultants following up their discharged patients with a home visit. That is going to be far more effective than a GP and in turn reduce re-admissions.

    I think discharged COPD (and asthma) patients should remain under the hospital team until they are fully back to their baseline (not just until they are ready to leave a hospital bed) and immediate recurrence or deterioration of their resp symptoms should be managed by the specialist care that they deserve.

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  • round our way there's a hosp Respiratory early discharge service-REDS - from the hospital which seems to be the business ,at least those deteriorated patients I have to seek readmission for are never the ones who have been under the REDS team...and a lot of those readmissions must still be in the category of unavoidable just because of the nature of severe copd.
    Did anyone point out to RCP that we ARE already reducing admissions in the first place by all our screening for early diagnoses,annual reviews and optimisation of treatment ,smoking cessation endeavours,referrals to pulmonary rehab etc -
    AND It's not the hospital teams going to be involved in taking large numbers of patients off the inhaled steroids we were advised to put them on, and dealing with the inevitable destabilisation of symptoms any large scale changes bring if new giuidelines turn up!

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  • Surely when they are discharged the patient will be right as rain and not require any further assessment/ treatment.

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