Nurse supported early discharge had a readmission rate similar to conventional hospital care in patients with exacerbations of chronic obstructive pulmonary disease
QUESTION: How does early discharge with home respiratory nurse support compare with conventional hospital management for subsequent need for readmission in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD)?
Randomised (allocation concealed), unblinded, controlled trial with 60 days of follow up.
A large university hospital in Glasgow, UK.
81 patients (mean age 67 y, 57% women) who were admitted on an emergency basis with an acute exacerbation of COPD. Exclusion criteria were other medical conditions that required inpatient investigation or management, acidotic respiratory failure, non-resident status in Glasgow, homelessness, or lack of telephone access. 93% of patients received their allocated intervention, but all patients were included in the intention to treat analysis.
41 patients were allocated to early discharge, 36 of whom were sent home the next working day after recruitment. These patients had home visits by specialist respiratory nurses on the first morning after discharge and thereafter at intervals determined by the nurse. Home treatment was based on the practice developed by the Acute Respiratory Assessment Service. The nurse assessed progress and could adjust treatment after discussion with respiratory medical staff. The nurse did not prescribe, but could advise patients on the use of “as required” medication.
40 patients were …