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International Journal of Chronic Obstructive Pulmonary Disease Volume 13, 2018 - Issue
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Original Research

The use of a standardized order set reduces systemic corticosteroid dose and length of stay for individuals hospitalized with acute exacerbations of COPD: a cohort study

Swati Gulati1 Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];2 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];3 UAB Lung Health Center, Birmingham, AL, USA, [email protected]
,
Aline N Zouk1 Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];2 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];3 UAB Lung Health Center, Birmingham, AL, USA, [email protected]
,
Jonathan P Kalehoff4 Division of Internal Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
,
Christopher S Wren5 Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
,
Peter N Davison6 University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
,
Denay Porter Kirkpatrick1 Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];2 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];3 UAB Lung Health Center, Birmingham, AL, USA, [email protected]
,
Surya P Bhatt1 Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];2 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];3 UAB Lung Health Center, Birmingham, AL, USA, [email protected]
,
Mark T Dransfield1 Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];2 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];3 UAB Lung Health Center, Birmingham, AL, USA, [email protected];7 Birmingham VA Medical Center, Birmingham, AL, USA, [email protected]
&
James Michael Wells1 Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];2 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA, [email protected];3 UAB Lung Health Center, Birmingham, AL, USA, [email protected];7 Birmingham VA Medical Center, Birmingham, AL, USA, [email protected]Correspondence[email protected]
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Pages 2271-2278 | Published online: 27 Jul 2018
 
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Abstract

Background

Systemic corticosteroids (SC) are an integral part of managing acute exacerbations of COPD (AECOPD). However, the optimal dose and duration vary widely in clinical practice. We hypothesized that the use of a “PowerPlan” order set in the electronic health system (EHS) that includes a 5-day SC order would be associated with a reduced steroid dose and length of stay (LOS) for individuals hospitalized with AECOPD.

Patients and methods

We conducted a retrospective cohort study of Medicare recipients discharged with an AECOPD diagnosis from our University Hospital from 2014 to 2016. Our EHS-based “COPD PowerPlan” order set included admission, laboratory, pharmacy, and radiology orders for managing AECOPD. The default SC option included intravenous methyl-prednisolone for 24 hours followed by oral prednisone for 4 days. The primary endpoint was the difference in cumulative steroid dose between the PowerPlan and the usual care group. Secondary endpoints included hospital LOS and readmission rates.

Results

The 250 patients included for analysis were 62±11 years old, 58% male, with an FEV1 55.1%±23.6% predicted. The PowerPlan was used in 72 (29%) patients. Cumulative steroid use was decreased by 31% in the PowerPlan group (420±224 vs 611±462 mg, P<0.001) when compared with usual care. PowerPlan use was independently associated with decreased LOS (3 days; IQR 2–4 days vs 4 days; IQR 3–6 days, P=0.022) without affecting 30- and 90-day readmission rates.

Conclusion

Use of a standardized EHS-based order set to manage AECOPD was associated with a reduction in steroid dose and hospital LOS.

Acknowledgments

SPB was supported by the NIH/NHLBI (5K23HL133438), CSW was supported by the NIH (5TL1TR1418), and JMW was supported by the NIH/NHLBI (K08HL123940).

Author contributions

All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

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