Assisted discharge for patients with exacerbations of chronic obstructive pulmonary disease: safe and effective

Every year the pressure of acute medical admissions rises and the NHS hits the headlines as admission rates peak in the winter. Many of these admissions are related to COPD, hence the development of interventions such as an acute respiratory assessment service pioneered in Glasgow.1 However, this kind of service, which takes direct referral from the GP and has its own beds and personnel running alongside a medical assessment unit, can be very expensive to run, and effectiveness may be difficult to assess. If admitted, patients who have experienced intensive rehabilitation may spend less time in hospital.2 Two studies in this issue break new ground by looking at patients with COPD once they have been admitted; is early discharge with an appropriate package of care feasible? Cotton et al 3 randomised patients between planned discharge “the next working day” and conventional management by a general physician in an acute hospital. Patients discharged early received domiciliary visits …