Authors: Sally Hickman and Dr Omorogieva Ojo
The purpose of this paper is to present the development and implementation of Early Supported Discharge (ESD) for those patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD). It also outlines the collaboration between secondary and primary care using Kotters 8-step change model.
Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) accounts for 1:20 emergency admissions daily, 500 of which are admitted spending an average of 6.5 days in hospital. Alternatives to managing exacerbation of COPD in a hospital setting were first suggested by the Royal College of Physicians in 1981. Emergency admissions for COPD place a significant burden on the resources of the NHS.
Methods: Kotters 8-step model of change was used in this study. All adult patients (55 years or older) admitted to the Acute Medical ward with an exacerbation of COPD were assessed for their suitability for ESD. The period of the study was from February to June 2011. The service was operational from Monday to Thursday, and between the hours of 09.00 and 12 midday. Patients admitted with the diagnosis of COPD
were identified by;
• Accessing admissions information via a
hospital information system
• Referral from nurse in charge of
• Referral from Doctors.
Results: The approach adopting a change model has resulted in a period of six months 27 patients being discharged under the ESD scheme. Only one patient was readmitted within 30 days.
Conclusion: Approaching the change in smaller steps encourages reflection and development of leadership skills, and analysing the small steps allowed the development of a clear strategy which moved ESD forward. This service development has been a very positive experience, in the main due to the collaboration between the Respiratory Nurses and COPD Team.
Keywords: Early supported discharge, Chronic Obstructive Pulmonary Disease, Community,
Primary care, Multidisciplinary team, Change management, Kotter's 8-step Model