PDF(Pubmed)
Abstract：
Discharge bundles, comprising evidence-based practices to be implemented prior to discharge, aim to optimise patient outcomes. They have been recommended to address high readmission rates in patients who have been hospitalised for an exacerbation of chronic obstructive pulmonary disease (COPD). Hospital readmission is associated with increased morbidity and healthcare resource utilisation, contributing substantially to the economic burden of COPD. Previous studies suggest that COPD discharge bundles may result in fewer hospital readmissions, lower risk of mortality and improvement of patient quality of life. However, evidence for their effectiveness is inconsistent, likely owing to variable content and implementation of these bundles. To ensure consistent provision of high-quality care for patients hospitalised with an exacerbation of COPD and reduce readmission rates following discharge, we propose a comprehensive discharge protocol, and provide evidence highlighting the importance of each element of the protocol. We then review care bundles used in COPD and other disease areas to understand how they affect patient outcomes, the barriers to implementing these bundles and what strategies have been used in other disease areas to overcome these barriers. We identified four evidence-based care bundle items for review prior to a patient\'s discharge from hospital, including (1) smoking cessation and assessment of environmental exposures, (2) treatment optimisation, (3) pulmonary rehabilitation, and (4) continuity of care. Resource constraints, lack of staff engagement and knowledge, and complexity of the COPD population were some of the key barriers inhibiting effective bundle implementation. These barriers can be addressed by applying learnings on successful bundle implementation from other disease areas, such as healthcare practitioner education and audit and feedback. By utilising the relevant implementation strategies, discharge bundles can be more (cost-)effectively delivered to improve patient outcomes, reduce readmission rates and ensure continuity of care for patients who have been discharged from hospital following a COPD exacerbation.
摘要：
放电束,包括在出院前实施的循证实践，旨在优化患者预后。建议将其用于解决因慢性阻塞性肺疾病（COPD）恶化而住院的患者的高再入院率。医院再入院与发病率和医疗保健资源利用率的增加有关，对COPD的经济负担有很大贡献。以前的研究表明，COPD出院束可能导致更少的再入院，降低死亡率和改善患者生活质量的风险。然而,它们有效性的证据不一致，可能是由于这些捆绑包的内容和实现不同。确保持续为COPD加重住院患者提供高质量护理，并降低出院后的再入院率。我们提出了一个全面的出院协议，并提供证据强调方案每个要素的重要性。然后，我们回顾了COPD和其他疾病领域使用的护理捆绑，以了解它们如何影响患者的预后。实施这些捆绑措施的障碍，以及在其他疾病领域使用了哪些策略来克服这些障碍。我们确定了四个基于证据的护理捆绑项目，用于患者出院前的审查，包括（1）戒烟和环境暴露评估，（2）治疗优化，（3）肺康复，（4）护理的连续性。资源限制,缺乏员工参与和知识，COPD人群的复杂性和复杂性是抑制有效集束化实施的一些关键障碍.这些障碍可以通过在其他疾病领域的成功捆绑实施中应用学习来解决，如医疗保健从业人员教育和审计和反馈。通过利用相关的实施策略，出院束可以更(成本)有效地交付，以改善患者的预后，降低COPD加重后出院患者的再入院率并确保护理的连续性.
