TABLE 3

Observed frequencies for each admission for management of acute exacerbation of COPD according to COPD-X guideline recommendations

CategoryCOPD-X guideline recommendation (version 2.34, November 2012)All sites (N=207)Site 1 (N=65)Site 2 (N=8)Site 3 (N=39)Site 4 (N=65)Site 5 (N=30)p-value
Confirm exacerbation and categorise severity“Unless confused or comatose, even the sickest of patients can perform an FEV1 manoeuvre” [p. 61]
FEV1 performed this admission/patients admitted
45/198 (22.7%)1/65 (1.5%)0/5 (0%)2/38 (5.3%)33/62 (53.2%)9/28 (32.1%)<0.001
“Arterial blood gas levels should be measured if the FEV1 is less than 1.0 L or less than 40% predicted” [p. 61]
ABG or VBG taken/patients with any documented FEV1 <1 L
86/106 (81.1%)23/31 (74.1%)3/3 (100%)8/13(61.5%)43/46(93.5%)9/13(69.2%)0.017
“Chest x-ray…helps to identify alternative diagnoses and complications” [p. 61]
Chest radiography performed/patients admitted
203/204 (99.5%)65/65 (100%)7/8 (87.5%)39/39 (100%)62/62 (100%)30/30 (100%)0.039
Optimise treatment“Oral corticosteroids hasten resolution and reduce the likelihood of relapse” [p. 61]
Prescribed corticosteroids/patients admitted
195/205 (95.1%)65/65 (100%)7/7 (100%)37/39 (94.2%)59/64 (92.2%)27/30 (90%)0.085
“Antibiotics are given for purulent sputum to cover for typical and atypical organisms” [p. 61]
Antibiotics prescribed/patients with change in sputum colour
95/100 (95.0%)30/32 (93.8%)2/3 (66.7%)14/15 (93.3%)35/35 (100%)14/15 (93.3%)0.085
“Oxygen therapy…indicated in patients with hypoxia… minimise excessive oxygen administration” [p. 61]
All patients who were administered oxygen therapy/patients admitted
180/202 (89.1%)52/65 (80.0%)8/8 (100%)32/36 (88.9%)61/63 (96.8%)27/30 (90.0%)0.034
“Oxygen therapy…indicated in patients with hypoxia… minimise excessive oxygen administration” [p. 61]
Patients who were administered oxygen therapy when PaO2 <80 mmHg and ABG taken on air this admission/all patients who had PaO2 <80 mmHg when ABG taken on air this admission
25/27 (92.6%)5/7 (71.4%)0/0 (0%)1/1 (100%)13/13 (100%)6/6 (100%)0.177
“Ventilatory assistance… indicated for increasing hypercapnia and acidosis” [p. 61]
Received ventilatory assistance/those with pH <7.35
21/32 (65.6%)6/8 (75%)0/2 (0%)4/6 (66.7%)9/14 (64.3%)2/2 (100%)0.429
Refer appropriately to prevent further deterioration“Pulmonary rehabilitation…can be initiated immediately following an acute exacerbation” [p. 66]
Referred to pulmonary rehabilitation/patients admitted
60/185 (32.4%)33/46 (71.7%)3/8 (37.5%)4/39 (10.3%)14/64 (21.9%)6/28 (21.4%)<0.001
“It is recommended that the first review after a hospital admission should be by the GP and within seven days of discharge” [p. 67]
Referred to GP/patients admitted
136/177 (76.8%)43/47 (91.5%)1/6 (16.7%)23/34 (67.7%)39/60 (65.0%)30/30 (100%)<0.001

Data calculated on individual admissions (n=207); % are for documented values (unrecorded, unknown and undocumented values have been treated as missing values). FEV1: forced expiratory volume in 1 s; ABG: arterial blood gas; VBG: venous blood gas; PaO2: arterial oxygen tension; GP: general practitioner.