Items not included in bundle	Explanation
Supplemental oxygen need assessment	A pre-existing process was already in place; nurses assess supplemental oxygen need by performing a walk test
Vaccinations (influenza and pneumococcus)	Baseline performance was adequate. Low failure rates on Pareto analysis
Follow-up within 7 days	See above in section of ‘follow-up within 15 days’
Pulmonary specialty consult	Did not alter current process of leaving to the medical teams’ discretion to consult as needed. Not all patients with COPD exacerbations require pulmonologist evaluation if the bundle items outlined above are standardised
Nebuliser prescription for inhaled medication	No difference in efficacy of inhaled versus nebulised medications
Smoking cessation education	44% of patients were active smokers in retrospective analysis, therefore this was not applicable to all patients. Would be up to the medical teams’ discretion to provide as needed. Will make this part of interventions for high-risk subgroup in future projects
Referral to pulmonary rehabilitation	Pulmonary rehabilitation referrals are left to the medical teams’ discretion for individual patients. Will make this part of interventions for high-risk subgroup in future projects. Also, our pulmonary rehabilitation is in infancy and cannot handle a large influx of referrals
Recognition and treatment of psychiatric or substance abuse disorder	26% had depression or bipolar disorder. 11% had known alcohol or substance abuse. Not applicable to all patients. Will consider this as part of interventions for high-risk subgroup in future projects
Follow-up phone calls	Insufficient evidence to support efficacy of follow-up phone calls. Requires additional resources and personnel. Anticipate better patient empowerment with above interventions selected for the COPD care bundle

COPD, chronic obstructive pulmonary disease; RCT, randomised controlled trial; LAMA, long-acting muscarinic antagonist; LABA, long-acting β-adrenergic agonist; ICS, inhaled corticosteroid; SABA, short-acting β-adrenergic agonist; GOLD, Global Initiative for Obstructive Lung Diseases.