COPD: Who Cares?, the report from the national Chronic Obstructive Pulmonary Disease (COPD) audit published 19 November 2014, has found that standards of care for patients with COPD have improved overall, but there is still wide variation and some hospitals are still not meeting national service standards.
COPD is the collective term for emphysema and chronic bronchitis. People with COPD have breathing difficulties, which can affect their everyday life. Smoking is the main cause of COPD. Treatment helps to manage COPD but there is no cure. The report describes the organisation and availability of COPD services across England and Wales, as recorded in 2014, and is published today to coincide with World COPD Day.
The National COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme (NCA)*. The Audit Programme is led by the Royal College of Physicians, working closely with stakeholders, including the British Thoracic Society (BTS), the Primary Care Respiratory Society UK (PCRS-UK), the British Lung Foundation (BLF) and the Royal College of General Practitioners (RCGP). The audit measured the essential aspects of care that a hospital should provide for COPD patients and found that some hospitals are not providing these services. This needs to change. There are national standards describing what COPD care should look like and all hospitals should be adhering to these standards.
There have been significant improvements in COPD care since 2008, including an increase in the average number of respiratory consultants from 3 to 4 per hospital and improvement in the availability of palliative care services (50% to 87%). The management of patients with respiratory failure has improved and there is better access for patients with COPD to teams who can support an early discharge from hospital.
However, unacceptable variation in COPD services remains in patient access to specialist care. The audit recommends that all patients admitted with a COPD exacerbation (flare up) should be cared for by respiratory specialists on a respiratory ward: this will enable the patient to receive, and benefit from, specialist care. When they do, the level of care is much better. The key findings of the report include:
- A 9% drop in access to specialist respiratory nurse care (80% in 2008, 71% in 2014) despite an increase in the number of people admitted with COPD.
- Patients on a respiratory ward have more access to specialist care from respiratory doctors and nurses compared with other wards (84% compared with 27%)
- Only 21% of hospitals have an on-call respiratory service operating 7 days a week, moreover, only 30% of critical care outreach teams operate out of hours during weekdays; 20% don’t operate at all at weekends.
- 37% of Units have no inpatient smoking cessation services, with an additional 34% reporting less than 0.5 of a Whole Time Equivalent (WTE) member of staff available to undertake this activity.
The key recommendations from the report include:
- Above all else, COPD patients admitted with an exacerbation should be cared for by respiratory specialists on a respiratory ward, seven days a week.
- All Hospitals/Units should have a fully-funded and resourced smoking cessation programme delivered by dedicated smoking cessation practitioners.
- All Hospitals/Units should make spirometry results accessible from every computer desktop; there should be a data sharing agreement between primary and secondary care that allows General Practice spirometry data to be made universally available.
- Post-discharge pulmonary rehabilitation services should be available within 4 weeks of referral.
- To improve local commissioning and service needs for COPD, audit data should be used to inform decisions and incorporated into local CQUINs to drive change.
The audit assessed the resources and organisation of COPD services against NICE quality standards for COPD.
Dr Robert Stone, COPD audit clinical lead for secondary care said,
‘More patients have access to supported discharge teams and assisted ventilation services are better organised. However, many patients in England and Wales are still unable to access specialist respiratory care on the right ward from the respiratory team. The availability of smoking cessation services and access to spirometry results (the key test of COPD diagnosis) is inadequate. The way we manage patients’ discharge from hospital needs to improve.’
Professor Mike Roberts, lead national COPD audit programme said,
‘We are pleased that many centres offer an absolutely first class service for COPD patients but we need to ask, is it acceptable in the 21st Century that patient experience and quality of care should be so variable? We know from previous audits that patients under the care of a respiratory specialist are more likely to receive evidence-based care and to benefit from specialist services such as supported discharge and pulmonary rehabilitation. We are calling for all Hospitals to provide the expertise of respiratory specialist teams, seven days a week.’ Dr Bernard Higgins, Chair of the BTS said,
‘The British Thoracic Society is pleased to see that this latest national audit shows improvement in several aspects of COPD care, and we congratulate all those whose hard work has helped achieve this. However, the variation in standards between hospitals is concerning. COPD admissions are common but they are rarely straightforward; people with this disabling disease need attention from healthcare professionals who really understand the optimum management of their condition. We therefore strongly support the call made by the audit programme leads for all hospitals to provide access to respiratory specialist teams and to smoking cessation services.’
A copy of the audit report will be available on the RCP website.
Source: Royal College of Physicians (RCP)