Immediate and early discharge for patients with exacerbations of chronic obstructive pulmonary disease: is there a role in “real life”?

Figures & data

Table 1 Demographics and results of randomized controlled trials evaluating the use of hospital at home or assisted discharge schemes

Study	Intervention	N	%	Mean age (years)	Mean FEV1 (litres)	Follow up (weeks)	Re-admission rate	Mortality	HRQL	Mean hospital stay
Skwarska et al 2000	HH	184	25	69	0.74	8	↔	↔	NA	NA
Shepperd et al 1998	HH	32	NA	72	NA	12	↔	↔	↔	NA
Ojoo et al 2002	AD	60	18	70	0.93	2	↔	↔	NA	NA
Hernandez et al 2003	HH or AD	222	35	71	1.1	8	↔	↔	↔	↓
Davies et al 2000	HH	150	26	70	0.69	12	↔	↔	↔	NA
Cotton et al 2000	AD	81	20	66	0.95	9	↔	↔	NA	↓

Abbreviations: AD, assisted discharge; FEV₁, forced expiratory volume in one second; HH, hospital at home; HRQL, health-related quality of life; N, total number of randomized subjects with COPD; NA, not documented or not measured in the study; ↔, no significant difference with active intervention versus conventional in-patient care; ↑, significant improvement with active intervention versus conventional in-patient care; ↓, significant reduction with active intervention versus conventional in-patient care; %, percentage of screened patients suitable for AD or HH.

Table 2 Numbers of patients (mean age 72 years) with mild exacerbations of COPD entered into our own assisted discharge scheme and frequency of readmission to hospital

Year	Number of assisted discharge episodes	Number of times readmission required
2002	207	13
2003	199	22
2004	184	6
2005	220	18*
Total over 4 years	810	59

* Note: 1 patient died at home.

Table 3 Numbers of patients having single and repeat episodes of assisted discharge for mild exacerbations of COPD over a 3 year period

Number of episodes of assisted discharge between 2002–2005	Number of patients
1	447
2	150
3	80
4	48
5	34
6	17
7	12
8	6
9	5
10	4
11	3
12	2
13	1
14	1

Table 4 Clinical features and social circumstances considered unsuitable for entering patients into our own assisted discharge scheme

Clinical features	Social circumstance
Confusion	No telephone
Worsening peripheral oedema	Patient, family, or General Practitioner unwilling
pH <7.35, pO2 < 8 kPa, pCO2 > 6.5 kPa	Home > 30 miles from base hospital
Heart rate > 110 beats per minute	Adverse home circumstances
Respiratory rate > 28 breaths per minute
Unable to complete sentences
Undiagnosed or cardiac chest pain

Abbreviations: pCO₂, partial pressure of carbon dioxide ; pO₂, partial pressure of oxygen.

Figure 1 Algorithm describing proposed protocol for entering patients into assisted hospital discharge.

Abbreviation: COPD, chronic obstructive pulmonary disease.

SkwarskaECohenGSkwarskiKM2000Randomized controlled trial of supported discharge in patients with exacerbations of chronic obstructive pulmonary diseaseThorax559071211050258

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ShepperdSHarwoodDGrayA1998Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysisBMJ316179169624069

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OjooJCMoonTMcGloneS2002Patients’ and carers’ preferences in two models of care for acute exacerbations of COPD: results of a randomised controlled trialThorax57167911828049

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HernandezCCasasAEscarrabillJ2003Home hospitalisation of exacerbated chronic obstructive pulmonary disease patientsEur Respir J21586712570110

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DaviesLWilkinsonMBonnerS2000“Hospital at home” versus hospital care in patients with exacerbations of chronic obstructive pulmonary disease: prospective randomised controlled trial”BMJ3211265811082090

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CottonMMBucknallCEDaggKD2000Early discharge for patients with exacerbations of chronic obstructive pulmonary disease: a randomized controlled trialThorax55902611050257

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