Abstract
Hospital admissions for acute exacerbations of COPD (AECOPD) can be shortened by nursing support for a period following discharge. Many suitable patients are denied this service by the difficiltiers hospital units have in providing it, and the shortage of trained respiratory nurses The government has endorsed partnerships between the NHS and private sector. We explored whether private sector nursing couls support such a service, where patiebnts were supervised by and returned to an experienced respiratory nurse specialist.
During the study period Portsmouth Trust had 276 admissions for AECOPD, of whom 118 received support discharge. The usual length of stay for this diagnosis is 6 days. During the service, most patients were discharged within 2 days.
67% of patients were classified as severe under the BTS COPD guidelines. 22 normally lived alone with no support. 18 were re-admitted. No additional social services support was required.
The nursing team 1 G grade and 1 F grade WTE, were supplemented by further F grades at the weekend and during holiday periods. They worked to a care plan agreed with the hospital team prior to the start of the service. Support was provided for an average of 5 hours during a ten day follow-up period, including 54 calls from 34 patients outside office hours. Patients had separate follow-up arrangements to their GP's normal service.
Patient satisfaction was very high with 86% agreeing or agreeing strongly that receiving care at home was important to them.
In a group of patients with severe disease, this service discharged 42% of patients which compares with about 30% in other studies. The flexibility of the private sector may help Trusts resource this important COPD service
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Footnotes
Dr Holmes is the Medical Director of Nestor healthcare Group which provides the service