COPD early discharge service

Purpose

COPD exacerbations can occur frequently causing lengthy hospital admissions with high re-exacerbation rates. Investment in a COPD EDS is an effective way in improving service and patient outcomes. Other areas may wish to consider adopting this model of care.

£157,262.40
potential annual saving
95% of urgent referrals
seen within 1 working day

Approach

Delivery of the COPD EDS changed in 2016 with additional funding from the Welsh Assembly Government. Two additional staff members were employed (creating a team of 3). Enhanced data collection methods were used; an Excel database, outcome measures (the COPD Assessment Test/ CAT and EQ-5D-5L) and patient satisfaction questionnaires to measure performance and impact. Support was extended from secondary care to primary care also, with GPs able to refer recurrent exacerbators at risk of hospital admission. Activity data was retrospectively analysed from the years 2015/16/17. More robust data was collected for the 2016-2017 4 month period. Length of stay (LOS) and cost information was obtained from health board data.

Outcomes

In 2015/16 192 patients were seen by the COPD EDS versus 389 in 2016/17. 95% of urgent referrals were seen within 1 working day demonstrating the ability of the service to provide an efficient response with increased staffing. Average LOS for a COPD exacerbation locally is 6.52 days versus 2.6 days with COPD EDS support . The COPD EDS is expediting discharges with an approximate cost saving of £480 per patient per admission. 18% of patients from secondary care seen by the COPD EDS were readmitted to hospital within 2 weeks of discharge. 52% of patients were not readmitted. Of patients who self-referred or were referred by their GP, 29% avoided an admission. This represents a cost saving of £18, 777.60. If non-readmissions (of secondary care referrals) are also considered this saving amounts to £33,643.20. Therefore over 4 months there has been a potential saving of £52,420.80 or an annually £157,262.40. The service is running cost neutrally whilst providing huge gains to patients, other service users and additional financial considerations such as emergency service use, GP visits and wasted medication. So far there have only been a small number of GP referrals owing to the newness of the project. Even so there has been a cost saving of £5,476.80, which will enlarge when greater numbers are referred. 98% of patients involved possessed a reduced CAT score post intervention, highlighting a lessened disease burden . Mean improvement in quality of life was 20% (EQ-5D-5L) within a progressive condition. Visual analogue scores improved in 85% of cases.

Cost and savings

Please see outcomes section above. 

Implications

The COPD EDS has demonstrated it can provide a timely and cost-effective service that leads to a greater proportion of the COPD population receiving appropriate care with the addition of extra staff. Benefits include cost savings, reduced LOS, admissions and readmissions, improved patient flow and outcomes.

A COPD EDS is a highly cost effective and quality resource when managing and supporting patients who experience acute exacerbations of COPD. Investment into this type of service leads to huge individual and service-wide benefits.

Fund acknowledgements

This work was unfunded.

Additional notes

This work was presented at Physiotherapy UK 2017.

For further information about this work contact Jade Bazylkiewicz.