Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease
Despite the existence of evidence-based management guidelines for acute exacerbations of chronic obstructive pulmonary disease (COPD), significant variability exists in the care provided to patients admitted to hospital for this reason.
This study explored the effectiveness of a standardised admission order set for patients with COPD exacerbations admitted to a hospital over a two-year period. The order set contained recommendations for tests, medication (including dosage and delivery method), consultations and discharge planning. To encourage their increased use, some interventions, such as physiotherapy referrals, were automatically pre-selected in the order set.
Median length of stay did not differ before and after the order set was implemented: 6.37 days in the pre-implementation period, and 6.02 days post-implementation. However, after the order set was implemented, length of stay was significantly shorter by 1.15 days for patients in whom the order set was used. Order set implementation and use was not associated with change in readmission, suggesting earlier discharge did not occur at the expense of patient harm, and that order sets may reduce the burden of acute exacerbations.