Nadeem Iftikhar, Light Alexander, Donaldson Callum, Khatana Usman Feroze, Bagmane Dinesh, Thomas Enson, Azher Mohammed
Lister Hospital, Stevenage, UK.
Addenbrookes Hospital, Cambridge, UK.
Future Healthc J. 2021 Mar;8(1):e123-e126. doi: 10.7861/fhj.2020-0097.
DECAF is a scoring tool that can predict severity in patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Previous research has shown AECOPD patients with DECAF scores of 0-1 are candidates for early discharge.
Plan, do, study, act (PDSA) methodology was used. Patients with AECOPD and a DECAF score of 0-1 were included. Notes were retrospectively reviewed for patients for DECAF score, length of stay, 30-day re-admission and 30-day mortality (PDSA cycle 1). A framework to facilitate early discharge for patients was subsequently established. Awareness was increased through teaching sessions, posters and targeted emails. To evaluate our improvements, the same parameters were collected prospectively (PDSA cycle 2).
DECAF score was assessed for no patients in PDSA cycle 1 (n=20) but was assessed for all patients in PDSA cycle 2 (n=14). Hospital stay was significantly decreased in PDSA cycle 2 (mean 0.29±0.45 days) compared with PDSA cycle 1 (mean 3.71±2.69 days; difference p<0.00001). Thirty-day re-admission and 30-day mortality was not significantly different between two groups.
DECAF protocol is safe and feasible in the district general hospital setting and can facilitate early discharge for patients with low severity AECOPD without any worrisome effects.
DECAF是一种可预测慢性阻塞性肺疾病急性加重期（AECOPD）患者病情严重程度的评分工具。既往研究表明，DECAF评分为0 - 1分的AECOPD患者可作为早期出院的候选对象。
采用计划、执行、研究、行动（PDSA）方法。纳入DECAF评分为0 - 1分的AECOPD患者。对患者的病历进行回顾性审查，以获取DECAF评分、住院时间、30天再入院率和30天死亡率（PDSA循环1）。随后建立了一个促进患者早期出院的框架。通过教学课程、海报和定向电子邮件提高了认知度。为评估改进效果，前瞻性收集相同参数（PDSA循环2）。
PDSA循环1（n = 20）中没有患者接受DECAF评分，但PDSA循环2（n = 14）中所有患者均接受了评分。与PDSA循环1（平均3.71±2.69天）相比，PDSA循环2的住院时间显著缩短（平均0.29±0.45天；差异p<0.00001）。两组之间的30天再入院率和30天死亡率无显著差异。
在地区综合医院环境中，DECAF方案是安全可行的，可促进低严重程度AECOPD患者的早期出院，且无任何不良影响。
