Lawlor et al Methods The study was conducted in St. James Hospital, Dublin. A retrospective review of all patients included in the ﬁrst 3 years (2002–2005) of the COPD early discharge programme was performed. Patient recruitment Referrals were made by the admitting medical team to the respiratory outreach service, that consists of 3 primary members, a clinical nurse specialist, a clinical specialist physiotherapist and an administrator. Back-up was provided by a medical team consisting of a respiratory registrar and consultant. Patients admitted with an exacerbation of COPD and a length of hospital stay not greater than 4 days were considered. Subjects Patients requiring hospital admission due to the severity of their exacerbation or co-existent medical problems were not considered suitable. Patients were also excluded on a discre- tionary basis due to poor performance status or inadequate social support. Inclusion criteria • A diagnosis of COPD. • Length of stay 4 days. • Arterial ph 7.35, partial pressure of carbon dioxide 8.0 kpa and partial pressure of oxygen 7.3 on room air (unless on domiciliary oxygen). • Good performance status and social support. Exclusion criteria • Co-existent medical problem eg, suspected malignancy, pulmonary embolus, cardiac failure. • Consolidation/effusion on chest X-ray. • Cognitive impairment or lack of social support. • Residence beyond the hospital catchment area. Intervention Once accepted, patients were discharged with a prescription and letter to advise their GP they were on the programme. They were visited by the nurse or the physiotherapist at home the day after discharge, with subsequent visits conducted over a 14-day period as required. In addition, contact numbers were provided for patients to avail of telephone support if required. Adjustment of treatment was performed after discussion with the medical team who also reviewed patients that failed to improve in an outpatients setting. 56 Evening and night cover was provided by patients GPs and the hospital emergency department. All patients were given further follow up appointments to see the team at 6 weeks and 3 months. The following care package was provided to patients post-early discharge; • Clinical assessment and examination. • Education regarding their condition and proper use of medication including inhalers and nebulizers. • Smoking cessation advice. • Chest physiotherapy. • Individual home exercise programme. • Provision of self management plans to suitable patients. • Contact numbers to reach the early discharge team. After the ﬁrst 3-month period, patients were advised to retain the supplied contact numbers for use if they felt a further exacerbation was developing. Under these circumstances they were provided with advice and, if appropriate, a same or next day appointment to see the early discharge team in an outpatient setting. Blood tests, sputum analysis, chest X-ray, and oral antibiotic and steroid treatment were provided if necessary. If admission was required the medical team on call were advised and proceeded to admit the patient. Control group To account for regression for the mean, a control group was compiled of 267 patients that included all patients admitted to St. James’ with an index hospitalization in 2004 for an exacerbation of COPD, excluding those accepted to the respiratory outreach service. Admission numbers before and after this index hospitalization were compared to determine whether, in the absence of respiratory out- reach intervention, admission rates would tend to decline for this cohort. Self management education A subgroup of 60 patients received formal self management education. These were selected on the basis of a single inclusion criterion; the ability to understand every topic on a list of key concepts relevant to COPD exacerbations. These included symptom monitoring, recognition of an exacerbation and medication use. In practice, at their 6-week follow-up appointment, patients were provided with a list of these topics (outlined in Table 1) and each one was discussed. Those patients who demonstrated an understanding of all the topics on the list were offered self management education. This included disease education and provision of medications to take in the event of an exacerbation including antibiotics, International Journal of COPD 2009:4