Reduced AECOPD hospital admission rate by using a decision flowchart in the emergency department

Background: Acute exacerbations of COPD (AECOPD) often require hospital admission (HA), resulting in increased healthcare costs. There is a need to identify patients that can be treated safely as an outpatient. Aims: Reducing HA rate by using a decision flowchart based on objective parameters in the emergency department (ED) to evaluate the need for HA. Methods: Patients with AECOPD in the ED of the Haga Teaching Hospital (The Hague, The Netherlands) between December 2015 and December 2016 were included after informed consent was given. The flowchart (fig.1) was applied to decide whether a patient needed to be admitted or could be treated as an outpatient. Data were compared to a retrospective cohort, consisting of patients in the ED with AECOPD between July 2014 and January 2015. Results: Compared to the retrospective cohort (n=100), the HA rate of the prospective cohort (n=46) reduced significantly, 81% vs 65.2% resp. (p=0.038). The baseline characteristics of both groups did not significantly differ from each other regarding to sex, age, FEV1 and Charlson Comorbidity Index. Readmission rate within 30 days and death within 6 weeks after discharge was not different between the two groups. Conclusions: The use of this flowchart in the ED may lead to less hospital admissions of patients with AECOPD, without an increase in readmission rate or death. The number of patients discharged from the ED increased by 83%.