Reducing COPD related readmission rates at Royal Stoke University Hospital (RSUH), UK: a Quality Improvement Project

Introduction: Reducing the number of readmissions after an acute exacerbation of COPD (AECOPD) remains a challenge. A number of strategies have been shown to reduce early readmission including early outpatient follow up and the use of validated scoring systems to highlight patients at high risk of readmission. The aim of our ongoing project is to reduce the readmission rate of above 40% to the National COPD audit average of 23%. Our initial intervention was to increasing the number of patients seen by the community respiratory team (CRT). Methods: From April 2018 we referred an increasing number of patients admitted with AECOPD to the CRT upon discharge. Our efforts were initially aimed at patients with PEARL scores above 5. We used pre-existing data sheets, already utilised for the national audit, to record referral data. The patients’ electronic records were then analysed 90 days after discharge to determine time to re-admission. Two cycles of analysis were completed 90 days after the April and May discharges. Results: The 90 day readmission rate owing to COPD for patients admitted in March 2018 fell from 46% to 35% and 40% for patients admitted in April and May respectively. The number of referrals for high risk patients (PEARL above 5) increased every month but in May, lower risk (PEARL less than 5) had a higher rate of referrals as well. Conclusion: Our QIP has shown promising results with some reduction in readmission rates after higher referral rates to the CRT. This is likely due to early management of unstable symptoms and exacerbations. More work is required in developing a fully integrated approach and analysing the effectiveness of different community therapies.