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Development of a patient-centred, evidence-based and consensus-based discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease
  1. Maria B Ospina1,
  2. Marta Michas2,
  3. Lesly Deuchar3,
  4. Richard Leigh4,
  5. Mohit Bhutani2,
  6. Brian H Rowe2,3,5,
  7. Darcy Marciniuk6,
  8. Donna Goodridge6,
  9. Gail Dechman7,
  10. Jean Bourbeau8,
  11. Meyer Balter9,
  12. Pat Camp10,
  13. Paul Hernandez11,
  14. Roger S Goldstein12 and
  15. Michael K Stickland2,3
  16. for the COPD PRIHS-2 Group
    1. 1 Department of Obstetrics and Gynecology and Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
    2. 2 Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
    3. 3 Alberta Health Services, Edmonton, Alberta, Canada
    4. 4 Section of Respiratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
    5. 5 Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
    6. 6 Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
    7. 7 School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
    8. 8 Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Québec, Canada
    9. 9 University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
    10. 10 Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
    11. 11 Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
    12. 12 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
    1. Correspondence to Dr Michael K Stickland; michael.stickland{at}


    Introduction Hospital and emergency department discharge for patients with chronic obstructive pulmonary disease (COPD) is often poorly organised. We developed a patient-centred, evidence-based and consensus-based discharge care bundle for patients with acute exacerbations of COPD.

    Methods A purposeful sample of clinicians and patients were invited to participate in a two-round Delphi study (July–November 2015). In round 1, participants rated on a seven-point Likert scale (1=not at all important; 7=extremely important) the importance of 29 unique COPD care actions. Round 2 comprised items selected from round 1 based on consensus (>80% endorsement for Likert values 5–7). A list of 18 care items from round 2 was discussed in a face-to-face nominal group meeting.

    Results Seven care items were included in the COPD discharge bundle based on clinician and patient input: (1) ensure adequate inhaler technique is demonstrated; (2) send discharge summary to family physician and arrange follow-up; (3) optimise and reconcile prescription of respiratory medications; (4) provide a written discharge management plan and assess patient’s and caregiver’s comprehension of discharge instructions; (5) refer to pulmonary rehabilitation; (6) screen for frailty and comorbidities; and (7) assess smoking status, provide counselling and refer to smoking cessation programme.

    Conclusion We present a seven-item, patient-centred, evidence-based and consensus-based discharge bundle for patients with acute exacerbations of COPD. Alignment with clinical practice guidelines and feasibility of local adaptations of the bundle should be explored to facilitate wide applicability and evaluation of the effectiveness of the COPD discharge bundle.

    • copd exacerbations

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    • Contributors MBO, RL, BHR, MB and MKS contributed to study conception and protocol development. MO, MM, LD, MB, RL, BHR and MKS contributed to study design and coordination of Delphi and nominal group phases. MBO performed the statistical analysis and drafted the paper. All authors provided critical revisions and contributed to editing of the paper for important intellectual content. MKS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding The study was funded by Alberta Innovates Health Solutions Partnership for Research and Innovation in the Health System Program; (AIHS PRIHS 201400390); Alberta Health Services.

    • Competing interests BHR’s research is supported by a Tier I Canada Research Chair in Evidence-based Emergency Medicine from the Canadian Institutes of Health Research (CIHR) through the Government of Canada.

    • Ethics approval University of Alberta Health Research Ethics Board (PRO00055500).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data from this work would be provided for those interested.

    • Collaborators Writing Committee Members for the COPD PRIHS-2 Group: Ron Damant (University of Alberta), Irvin Mayers (University of Alberta), Jerry Hall (Royal Alexandra Hospital), Lee Green (University of Alberta), Charles Yan (Institute of Health Economics), Sachin Pendharkar (University of Calgary), Chris Mody (University of Calgary), Stephen Field (University of Calgary), Brandie Walker (University of Calgary), Tara Lohman (University of Calgary), Michael Roman (University of Calgary), Jim Graham (Alberta Health Services), Peter Farris (Alberta Health Services), Allan Ryan (Alberta Health Services), Kelly Mrklas (Alberta Health Services), Roberta Dubois (Alberta Health Services).

    • Presented at Poster presentation at (1) American Thoracic Society 2016 International Conference; 13-18 May 2016; San Francisco, California (USA); and (2) Canadian Respiratory Conference 2016; 14-16 April 2016; Halifax, Nova Scotia (Canada).

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