Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
BMC Pulm Med. 2018 May 30;18(1):93. doi: 10.1186/s12890-018-0657-x.
Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay.
The order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital. The primary outcome was length of stay for patients admitted during order set implementation period, compared to the previous 12 months. Secondary outcomes included length of stay of patients admitted with and without order set after implementation, all-cause readmissions, and emergency department visits.
There were 556 admissions prior to and 857 admissions after order set implementation, for which the order set was used in 47%. There was no difference in overall length of stay after implementation (median 6.37 days (95% confidence interval 5.94, 6.81) pre-implementation vs. 6.02 days (95% confidence interval 5.59, 6.46) post-implementation, p = 0.26). In the post-implementation period, order set use was associated with a 1.15-day reduction in length of stay (95% confidence interval - 0.5, - 1.81, p = 0.001) compared to patients admitted without the order set. There was no difference in readmissions.
Use of a computerized guidelines-based admission order set for COPD exacerbations reduced hospital length of stay without increasing readmissions. Interventions to increase order set use could lead to greater improvements in length of stay and quality of care.
急性加重期慢性阻塞性肺疾病（AECOPD）患者的住院管理差异可能会延长住院时间，增加医院获得性并发症的风险，并降低生活质量。我们旨在确定基于循证的 AECOPD 入院医嘱集是否可以改善质量并缩短住院时间。
该医嘱集由省级 COPD 工作组设计，并在加拿大一所三级教学医院的三个医生组中自愿实施。主要结局是实施医嘱集期间入院患者的住院时间与前 12 个月相比。次要结局包括实施后使用和不使用医嘱集入院患者的住院时间、全因再入院率和急诊就诊率。
实施前有 556 例入院，实施后有 857 例入院，其中有 47%使用了医嘱集。实施后总住院时间无差异（中位数 6.37 天（95%置信区间 5.94,6.81）vs. 6.02 天（95%置信区间 5.59,6.46），p=0.26）。在实施后期间，与未使用医嘱集的患者相比，使用医嘱集可使住院时间缩短 1.15 天（95%置信区间-0.5, -1.81，p=0.001）。再入院率无差异。
使用基于计算机的 COPD 加重症指南入院医嘱集可缩短住院时间，而不会增加再入院率。增加医嘱集使用的干预措施可能会进一步改善住院时间和医疗质量。
