Purpose: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines provide recommendations for the management of chronic obstructive pulmonary disease (COPD) exacerbation. Studies have demonstrated shortened hospital length of stay (LOS) with use of guideline-adherent systemic corticosteroid therapy. There are no published studies evaluating the impact of an inpatient orderset on patient-oriented outcomes.
Methods: This institutional review board-approved, retrospective, quasi-experimental, single-center cohort study included adult patients admitted to an internal medicine service for a documented COPD exacerbation from January 2014 through December 2015 (the pre-orderset group) or January 2017 through December 2018 (the post-orderset group). A pharmacy and therapeutics committee-approved orderset recommending guideline-adherent treatment with systemic corticosteroids, scheduled short-acting bronchodilators, and antibiotics was used in the post-orderset group. The primary outcome was hospital LOS. Secondary outcomes included 30-day all-cause and COPD-related readmission rates, systemic corticosteroid-related adverse events, and antibiotic use.
Results: A total of 358 unique patient encounters were identified for the pre-orderset group (n = 220) and post-orderset group (n = 138). The mean (SD) hospital LOS was significantly shorter in the post-orderset group (3.4 [2.4] days vs 4.3 [3.0] days; P = 0.004). There were no significant between-group differences in rates of 30-day all-cause and COPD-related readmissions. The overall rate of antibiotic use was lower in the post-orderset group vs the pre-orderset group (71% vs 90.2%; P < 0.001). The rate of occurrence of new blood glucose elevation was significantly lower in the post-orderset group (49.3% vs 79.1%; P < 0.001), with no significant between-group difference in occurrence of new blood pressure elevation.
Conclusion: A significant reduction in hospital LOS was found with the implementation of a pharmacist-driven COPD exacerbation orderset.
Keywords: COPD; chronic obstructive pulmonary disease; corticosteroid; exacerbation; length of stay; orderset.
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