COPD National Audit Programme: Resources and organisation of Care in hospitals: Time to integrate care
This report presents the results from a snapshot audit of the organisation and resourcing of COPD care that was undertaken in hospitals in England and Wales in the spring of 2017. Where possible, the results are displayed alongside the equivalent results from the previous audits (in 2014, 2008 and 2003). The recommendations in this report should be considered alongside the recommendations from the earlier audit reports.
The standout observations from this round of audit are the:
- increase in the median number of emergency, respiratory and COPD admissions (although it
is not known whether this is due to increased prevalence or acuity of the cohort, or to a rise in avoidable admissions)
- improved access to respiratory teams, despite the increase in workload and scant change in staffing levels
- under-provision of respiratory beds (including level 2‡ on respiratory wards): the majority of COPD patients are treated on non-respiratory wards where specialist care access is lowest
- improved (but still less than ideal) access to PR within 4 weeks of discharge
- improved provision of palliative care and integrated, cross-sector services
- reduced access to respiratory teams and cross-sector care at weekends
- reduced provision of inpatient smoking cessation services.
It appears from these data, and from data that were previously published by the audit programme,1,2 that the following key improvements are needed:
- reduced admissions and readmissions
- more COPD patients cared for on respiratory wards
- improved access to integrated, cross-sector respiratory services
- improved access to respiratory care at the weekends.
To achieve these objectives, and to ensure that patients receive the best COPD care all week, respiratory teams should collaborate across the sectors with other healthcare professionals in primary and secondary care. Respiratory teams should work with commissioners and emerging integrated care structures to develop the necessary service reorganisation and resource.
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