Background: COPD accounts for around 30,000 deaths per year in the UK (Nacul LC et al. Popul Health Metr. 2007; 5:8), with the highest risk seen in the 12 months following an exacerbation. A dedicated nurse-led COPD service at our hospital works to assess, treat, facilitate discharge and follow up patients following acute exacerbation of COPD. It receives referrals from wards, community healthcare teams and patients themselves. Aims: To ascertain risk factors for mortality in patients managed by our COPD unit in the ensuing 12 months after presentation. Methods: Data on 100 consecutive patients seen from January 2014 was assessed for factors which may contribute to disease progression, such as BMI, smoking status, deprivation index, comorbidity, sputum culture, and blood gas analysis. We tested these variables as risk factors for mortality using a binomial logistic regression analysis. Results: The 12 month mortality was 20% in our cohort, with ward-referral patients 2.3 times more likely than self-referrals to die (p=0.179). Of the other factors, patients with hypercapnoea (odds ratio 2.407, p=0.019, 95% CI 1.157 to 5.008) and sputum non-producers (odds ratio 5.938, p=0.043, 95% CI 1.057 to 33.350) had significantly higher mortality rates. Conclusion: Patients requiring hospitalization had a higher mortality rate, perhaps indicating more severe disease. In keeping with the literature, patients with hypercapnoea and sputum non-producers (emphysema phenotypes) are at higher risk of mortality(Groenwegen et al. Chest 2003;124:459-67). These factors should not only alert clinicians to patients requiring more intensive management and monitoring but also for whom advance care planning may be appropriate.

Background: COPD is associated with progressive morbidity leading to increased use of healthcare resources including hospital admissions. Our nurse-led COPD service works to assess, treat, facilitate discharge and follow up patients with acute exacerbation. It receives referrals from hospital wards, community healthcare teams and patients themselves. Aims: To ascertain factors leading to 90-day readmissions in patients managed by the COPD unit and to evaluate for correlation between source of referral and readmission. Methods: Data on 100 consecutive patients seen by the COPD service from January 2014 was evaluated for smoking status, social circumstances, deprivation index, co-morbidity, body mass index, sputum culture, and blood gas analysis. We tested these as risk factors for readmission using a binomial logistic regression analysis. Results: The 90-day readmission rate was 19%, with ward referral patients being 3.4 times more likely to be readmitted than self-referrals (p=0.067). Amongst the other variables, the only significant risk factor for readmission was presence of co-morbidity (odds ratio 2.014, p=0.022, 95% CI 1.106 to 3.666). Conclusion: Our readmission rates are significantly lower than the UK average (Price, LC et al. Thorax 2006; 61:837-84) (Buckingham, RJ et al. 2008 Report of the National COPD Audit 2008). It reflects the intensive support our COPD service provides post-discharge. In-patients with co-morbidities are more likely to be readmitted due to disease burden. Further research comparing usual vs targeted management of co-morbidity in COPD patients should be undertaken to see if it can reduce readmission rates.

Background The Royal College of Physicians COPD audit (Buckingham RJ et al, 2008) showed that patients presenting with AECOPD have a 33% re-admission rate within 90 days of index presentation. It is not clear if the high re-admission rate is due to disease deterioration or a lack of support at home. This places high workload on busy general practitioners and hospitals. Aims and Objectives To observe if weekly domiciliary visits for 2 weeks and successive telephone consultations for 4 weeks following index presentation of AECOPD, is effective in reducing re-admission. Methods Patients who accessed our acute COPD service from 09-09-2013 to 15-11-2013 (68 days) were included. Patients were excluded if they lived out of area or had other diagnoses. The patients taken into the scheme underwent an initial assessment and optimisation of current treatment. They received 2 domiciliary visits over a fortnight followed by weekly telephone follow up consultations over 4 weeks, they were then discharged from the service 6 weeks after the initial presentation. Results 86 patients {51 female: mean (range) age 67.2 (46-82) years} were included, 6 died during the scheme and were excluded from further analysis. 17 (21%) of the remaining 80 patients were re-admitted with AECOPD within 90 days of the index admission. Conclusions We have shown a 6 week domiciliary and telephone follow-up service appreciably the re-admission rate of patients with AECOPD. Thus reducing admission pressures to hospital and providing reliable support to patients in the community. {If accepted we will present data for the full project - till 31-12-2013}.