Chest
Volume 111, Issue 1, January 1997, Pages 89-94
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Clinical Investigations: COPD
Reducing Length of Stay for Patients Hospitalized With Exacerbation of COPD by Using a Practice Guideline

https://doi.org/10.1378/chest.111.1.89Get rights and content

Clinical practice guidelines have been promoted as an effective way of reducing costs while maintaining quality care.

Objective

To study a practice guideline to shorten length of stay for patients hospitalized with exacerbation of COPD.

Methods

We retrospectively studied a practice guideline to identify patients who were at low risk of complications from their exacerbation of COPD and hence potentially suitable for early hospital discharge. We then prospectively studied the practice guideline using an alternate month intervention and control time series over a period of 12 months.

Results

The practice guideline was retrospectively studied in 250 consecutive patients hospitalized with exacerbation of COPD. Of the 250 patients, 237 patients (94.8%) were classified as low risk after 72 h of hospitalization and were potentially suitable for discharge. In the prospective study, few patients (24 of 124 or 19%) were identified for implementation of the guideline. However, in those patients who were identified, length of stay was not statistically different. The data also showed that length of stay for both intervention and control groups had shortened over this time.

Conclusion

Certain practice guidelines may appear efficacious in studies but may actually lack effectiveness when applied in clinical settings and may even increase costs. We demonstrated the importance of prospectively evaluating clinical practice guidelines before recommending them for widespread implementation.

Section snippets

Methods

The study was a retrospective analysis of patients hospitalized with exacerbation of COPD. Patients were classified at low risk for development of complications according to the guideline. We investigated the potential effects of the guideline in recommending a 3-day length of hospital stay and on quality of care. We then went on to determine if the practice guideline studied would have an impact on shortening length of stay while maintaining or improving quality of care.

Description of the Institution

The study was performed

Retrospective Analysis

Demographics: A total of 250 patients were included in the study. Medical records were available for abstraction on 97.8% of eligible patients. The average age of the study patients was 71.5 years (SD, 11.6). Women accounted for 68% of the patients. The mean hospital length of stay was 6.5 days (SD, 4.8). The outcomes of the patients were as follows: 94% discharged to home; 4.4% transferred to another facility; and 1.6% deaths.

The proportion of patients classified as low risk according to the

DISCUSSION

Patients hospitalized with exacerbation of COPD are commonly treated in the short-term care setting for approximately 6 to 8 days, although there is little evidence to suggest that this length of stay is necessary for all patients.9 The retrospective study demonstrates that when patients are classified as low risk according to our guideline, the hospital length of stay could potentially be shortened to 3.2 days, with probably little effect on quality of care. As a consequence of this shortening

ACKNOWLEDGMENTS

We would like to thank Patricia Hobson, RN, Susan Edinger, RN, and Mary Reidinger, RN, for assistance in the collection of prospective data and with the statistical analysis.

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