O R I G I N A L R E S E A R C H Early discharge care with ongoing follow-up support may reduce hospital readmissions in COPD Maria Lawlor1 Sinead Kealy1 Michelle Agnew1 Bettina Korn1 Jennifer Quinn1 Ciara Cassidy1 Bernard Silke2 Finbarr O’Connell1 Ror y O’Donnell1 1Department of Respiratory Medicine, CResT Directorate, St. James’ Hospital, Dublin 8, Ireland; 2Department of General Internal Medicine, Gems Directorate, St. James’ Hospital, Dublin 8, Ireland Correspondence: Rory O’Donnell Department of Respiratory Medicine, CResT Directorate, St. James’s Hospital, Dublin, Ireland Email rodonnell@stjames.ie Background: Early discharge care and self-management education, although effective in the management of chronic obstructive pulmonary disease (COPD), do not typically reduce hospital re-admission rates for exacerbations of the disease. We hypothesized that a respiratory outreach programme that comprises early discharge care followed by continued rapid-access out-patient support would reduce the need for hospital readmission in these patients. Methods: Two hundred and forty-six patients, acutely admitted with exacerbations of COPD, were recruited to the respiratory outreach programme that included early discharge care, follow- up education, telephone support and rapid future access to respiratory out-patient clinics. Sixty of these patients received self-management education also. Emergency department presentations and admission rates were compared at six and 12 months after, compared to prior to, participation in the programme for the same patient cohort. Results: The frequency of both emergency department presentations and hospital admissions was signiﬁcantly reduced after participation in the programme. Conclusions: Provision of a respiratory outreach service that includes early discharge care, followed by education, telephone support and ongoing rapid access to out-patient clinics is associated with reduced readmission rates in COPD patients. Keywords: COPD management outreach, follow-up, out-patient clinics Introduction Chronic obstructive pulmonary disease (COPD), characterised by progressive, irreversible airways obstruction in smokers,1 is the fourth leading cause of death in the western world.2 Exacerbations of the disease account for up to one in eight emergency hospital admissions in the UK and recurrent hospitalizations, particularly feared by COPD patients,3,4 contribute signiﬁcantly to disease morbidity. Effective management strategies that have been studied include early discharge/hospital in the home interventions and self-management education.5–10 However, with the exception of one self-management programme,11 neither intervention has been shown to reduce hospital readmission rates.5,8,10,12,13 The Respiratory Department in St. James’s Hospital, Dublin provides a nurse and physiotherapist-led respiratory outreach service, with early discharge care, hospital in the home follow up and self-management education for a large inner city COPD population. In addition, for patients admitted to the programme, ongoing telephone support is provided with rapid access to respiratory outpatient clinics for future exacerbations. We performed a retrospective review of acutely admitted COPD patients that were discharged on this programme over a 3-year period. We compared emergency department presentations and hospital readmission rates in the same cohort before and after their participation in the programme. International Journal of COPD 2009:4 55–60 © 2009 Lawlor et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 55