Doctors' checklist could help decrease length of COPD patients' hospital stay
Patients with worsening chronic obstructive pulmonary disease spend less time in hospital when their doctors manage their care by using a checklist of steps called order sets.
Order sets help doctors and other clinicians choose the most appropriate care for a patient and can help improve care across several diseases. A new study, published today in the Canadian Respiratory Journal and led by Dr. Samir Gupta, is the first to examine the impact of order sets on patients with worsening COPD.
COPD, a lung disease that includes chronic bronchitis and emphysema, is the fourth leading cause of death globally and is the leading cause of hospitalization in Canada.
"Using order sets to manage worsening COPD can lead to better medical care and better results for patients," said Dr. Gupta, a respirologist at St. Michael's Hospital. "By providing doctors with the best, evidence-based information at the point in time when they are deciding on medications and tests for their patients, we can improve doctors' adherence to best practices."
As part of the study, physicians and staff were encouraged to use an order set developed by a team from the respirology and internal medicine wards at St. Michael's for all patients admitted with worsening COPD. The order set provided comprehensive admission instructions.
Patients' length of stay in hospital dropped by about two-and-a-half days when the order set was used.
"This is a dramatic drop, and points to one of the key, positive findings in our research," said Dr. Gupta. "The faster we can get patients home and breathing easier, the better for our patients and for our health-care system."
The study also found that order sets increased the proportion of patients who were prescribed corticosteroids, which can help keep COPD patients out of the intensive care unit by controlling the inflammation in their lungs.
More patients also received the correct antibiotics, which means that order sets can lead to less over-treatment and ultimately, may lead to less antibiotic resistance.
"At the end of the day, this is all about improving care and outcomes for patients," said Dr. Gupta. "Our next step is to advocate for these order sets to be implemented across the health-care system, to ensure that these patients receive best evidence-based and standardized care."