Table 6.

Interventions and Quality Indicators Planned for Phase 2 of ED AECOPD QI Project

Intervention	Indicators
Goal 1: Improve/Standardize COPD diagnosis
History checklist	Formulation of checklist and Percentage of ED patients with chronic respiratory symptoms who were assessed with the checklist
Spirometry	Increased percentage of patients with AECOPD who has a spirometry evaluation done (in the previous 15 months)
Echo	Increased percentage of patients with AECOPD who has echocardiography done
Goal 2: COPD emergency care bundle
Noninvasive ventilation	Increased percentage of patients with NIV used
Lung ultrasound (LUS)	Increased use of LUS in dyspnoeic patient in the ED
Clinical practice guidelines (agreed with internal medicine department)	Guidelines designed and adherence to the guidelines.
Goal 3: COPD discharge care bundle
Agreed discharge criteria Written action plan for self-management Drug reconciliation and education Ensuring proper inhaler technique Home oxygen education Counselling about smoking cessation and wood fire exposure	Formulation of discharge checklist Formulation of written action plan. Drugs checked and revised. Number of patients whom the inhaler technique checked and reinforced. Number of patients with education on domiciliary oxygen. Number of patients in whom smoking cessation counselling and harmful effects of woodfire exposure was done
Goal 4: Referral and follow-up
Planned follow up in OPD Referral to pulmonary rehabilitation Vaccination counselling	Number of patients with planned follow up in the OPD Number of patients attending pulmonary rehabilitation. Increased percentage of patients with COPD assessed for vaccination status and received immunization.

Abbreviations: AECOPD, acute exacerbation of chronic obstructive pulmonary disease; ED, emergency department; LUS, lung ultrasound; OPD, outpatient department; QI, quality improvement.