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Hospitals still letting down many COPD patients

Call for better access to specialist inpatient and rehabilitation services

Louise Prime

Thursday, 20 November 2014

Hospitals in England and Wales are still letting down too many people with chronic obstructive pulmonary disease, warn doctors. The latest COPD audit from the Royal College of Physicians shows that although standards of care have improved overall, there are some hospitals that are not meeting national service standards – and there is also wide regional variation in access to specialist care.

The authors of COPD: Who cares? reported that there are now an average of four respiratory consultants per hospital, up from three in 2008; there is better management of patients with respiratory failure; and patients with COPD have better access to teams who can support their early discharge from hospital. In addition, the availability of palliative care services has increased dramatically, from 50% to 87%.

However, the audit – supported by the Royal College of General Practitioners, the British Thoracic Society, the Primary Care Respiratory Society UK and the British Lung Foundation – showed:

  • an increase in the number of COPD admissions but a drop of over 11% in access to specialist respiratory nurse care (80% in 2008, 71% in 2014)
  • a huge discrepancy in patients’ access to specialist care by respiratory doctors and nurses – 84% on respiratory wards compared with 27% on other wards
  • only 21% of hospitals have an on-call respiratory service operating 7 days a week, and 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, and a further third (34%) have less than 0.5 of a whole time equivalent (WTE) member of staff available for this.

The report’s authors recommend that COPD patients admitted with an exacerbation should be cared for by respiratory specialists on a respiratory ward, 7 days a week, and that post-discharge pulmonary rehabilitation services should be available within 4 weeks of referral. They say all hospitals/units should make spirometry results accessible from every computer desktop, and there should be a data-sharing agreement between primary and secondary care that allows general practice spirometry data to be made universally available. They also call for all hospitals/units to have a fully-funded and resourced smoking cessation programme delivered by dedicated practitioners.

Dr Robert Stone, COPD audit clinical lead for secondary care, welcomed the improved access to supported discharge teams and assisted ventilation services, but said he was concerned that so many patients still don’t have specialist respiratory care in the right ward. He added: “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.”

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