Changes in NHS organization of care and management of hospital admissions with COPD exacerbations between the national COPD audits of 2003 and 2008

Background: The 2003 UK Chronic Obstructive Pulmonary Disease (COPD) audit revealed wide variability between hospital units in care delivered. Aims: To assess whether processes of care, patient outcomes and organization of care have improved since 2003. Design: A UK national audit was performed in 2008 to survey the organization and delivery of clinical care provided to patients admitted to hospital with COPD. Methods: All UK acute hospital Trusts (units) were invited to participate. Each unit completed cross-sectional resource and organization questionnaires and a prospective clinical audit comprising up to 60 consecutively admitted cases of COPD exacerbation. Comparison between 2003 and 2008 includes aggregated statistics for units participating in both audit rounds. Results: A total of 192 units participated in both audit rounds (6197 admissions in 2003 and 8170 in 2008). In 2008, patients were older and of a poorer functional class. Overall mortality was unchanged but adjusting for age and performance status, inpatient mortality ( P  = 0.05) and 90-day mortality ( P  = 0.001) were both reduced in 2008. More patients were discharged under a respiratory specialist ( P  < 0.01), treated with non-invasive ventilation if acidotic ( P  < 0.001) and accepted onto early discharge schemes ( P  < 0.01) while median length of stay fell from 6 to 5 days ( P  < 0.001). Within these mean data, however, there remains considerable inter-unit variation in organization, resources and outcomes. Conclusions: Overall improvements in resources and organization are accompanied by reduced mortality, shorter admissions and greater access to specialist services. There remains, however, considerable variation in the quality of secondary care provided between units.