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Evid Based Nurs 4:89 doi:10.1136/ebn.4.3.89
  • Treatment

Home supported discharge was as effective and safe as standard hospital admission in patients with chronic obstructive pulmonary disease


 
 QUESTION: Is immediate or next day home supported discharge as effective and safe as standard hospital admission in patients presenting to hospital with an exacerbation of chronic obstructive pulmonary disease (COPD)?

Design

Randomised {allocation concealed}*, unblinded, controlled trial with 8 weeks of follow up.

Setting

A hospital in Edinburgh, UK.

Patients

184 patients (mean age 69 y, 53% women) who presented to hospital on a weekday with an exacerbation of COPD. Exclusion criteria were an impaired level of consciousness, acute confusion, acute changes on radiography, an arterial pH <7.35, or a serious medical or social reason for admission. Follow up was 93%.

Intervention

122 patients were allocated to home support and were discharged immediately or the next day with an appropriate treatment package (antibiotics, corticosteroids, nebulised bronchodilators, and, if necessary, home oxygen). These patients had a home visit by a respiratory nurse the day after discharge and every 2–3 days thereafter until recovery, at which time they were discharged from follow up. Nurses reviewed patient progress weekly with the consultant. Specialist advice was available daily and changes in prescription could be obtained in consultation with the patient's general practitioner (GP). 62 patients were allocated to hospital admission with standard care in …

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