Needs Assessment and Identification of the Multifaceted COPD Care Bundle in the Emergency Department of a Tertiary Hospital in Nepal

• DOI: 10.2147/copd.s285744
• Publication Date: 2021-01-21T21:10:31Z
• Authors: Roshana Shrestha; Anmol Purna Shrestha; Taylor Sonnenberg; Janki Mistry; Rajeev Shrestha; Theodore MacKinney
• Keywords: RC705-779; International Journal of Chronic Obstructive Pulmonary Disease; resource-limited setting; near fatal outcome; quality improvement; 3. Good health; Tertiary Care Centers; Diseases of the respiratory system; Pulmonary Disease, Chronic Obstructive; 03 medical and health sciences; Cross-Sectional Studies; 0302 clinical medicine; Nepal; root cause analysis; Disease Progression; Humans; Prospective Studies; Emergency Service, Hospital; clinical practice guideline; performance measure; Needs Assessment; Patient Care Bundles; Original Research

Purpose: Acute care of patients with exacerbation chronic obstructive pulmonary disease (AECOPD) in the emergency department (ED) is crucial, however not studied extensively Nepal.The purpose this study to identify opportunities for succinct measures optimize AECOPD ED a multifaceted bundle approach resource-limited setting.Methods: We conducted prospective cross-sectional observational as an initial baseline stage quality improvement project.Demographic data, clinical characteristics, current diagnosis and treatment performances were recorded.The primary outcome 30-day revisit near-fatal events which compared other variables binary logistic regression.The multidisciplinary team performed root cause Pareto analysis potential gaps care. Results:The performance suboptimal.Written management guidelines advice regarding rehabilitation absent.Among 249 encounters, bilevel positive-airway pressure ventilation was started 6.4%.At discharge, 11.8% 39.7% given oral steroids antibiotics respectively; 2.2% advised vaccination.Near-fatal occurred 19% 38.2% encounters respectively.Those who required domiciliary oxygen had significantly higher revisits (OR=2.5;95% CI=1.43-4.4;P value =0.001) did those previously admitted (OR=1.98;95% CI 1.11-3.59;P =0.022).Those increased (OR=2.86;95% CI=1.362-6.18;P =0.006).The improving identified feasible interventions their indicators are summarized future implementation. Conclusion:The COPD suboptimal high outcomes.We suggest urgent implementation enlisted bundles-care involving protocol-based plans busy ED.