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Reducing hospital admissions for COPD: perspectives following the Christchurch Earthquake
  1. Michael Epton1,
  2. Carol Limber2,
  3. Carolyn Gullery2,
  4. Graham McGeoch3,
  5. Brett Shand3,
  6. Rose Laing4,
  7. Simon Brokenshire5,
  8. Andrew Meads5 and
  9. Rachel Nicholson-Hitt5
  1. 1 Department of Respiratory Medicine, Christchurch Hospital, Christchurch, New Zealand
  2. 2 Planning and Funding and Decision Support, Canterbury District Health Board, Christchurch, New Zealand
  3. 3 The Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
  4. 4 Canterbury Clinical Network, Canterbury District Health Board, Christchurch, New Zealand
  5. 5 Pegasus Health Ltd, Christchurch, New Zealand
  1. Correspondence to Dr Michael Epton; michael.epton{at}


The devastating 2011 earthquake in Christchurch destroyed or badly damaged healthcare infrastructure, including Christchurch Hospital. This forced change in management of exacerbations of chronic obstructive pulmonary disease (COPD), which until that point had frequently led to admission to hospital and focused attention on providing safe community options for care. This paper describes the process of understanding factors contributing to high admission frequency with exacerbations of COPD and also describes a process of change, predominantly to healthcare delivery systems and philosophies, and the subsequent outcomes. What became clear in understanding admissions with COPD to Christchurch Hospital was that the behaviour of the patient, in the context of exacerbations, and the subsequent response of the system to the patient, led to admission being the default option, in spite of low severity of the exacerbation itself. By altering systems’ responses to exacerbations, with a linked care process between ambulances, community care and hospitals, we were able to safely reduce admissions for COPD, with a sustained overall reduction in bed-day occupancy for COPD of ~48%. We would encourage these discussions and changes to occur without the stimulus of an earthquake in your healthcare environment!

  • copd exacerbations
  • earthquakes
  • hospitalisation
  • patient care
  • general practice
  • ambulances
  • access to information
  • safety

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  • Contributors The work group for programme development consisted of ME as a Community Respiratory Physician in the Canterbury Clinical Network, CL as a Service Improvement Lead for the Canterbury DHB, GM as Clinical Leader in the Canterbury Initiative, RL as GP Liaison for Respiratory and General Medicine in the Canterbury Initiative, SB as Clinical Director of the 24-hr Observation Unit, Pegasus Health, AM as Medical Director of the Acute Demand Management Programme and RN-H the Lead from St John Ambulance, Christchurch. ME and BS collected and generated the data and wrote the article. All authors contributed to the development of the manuscript and approved the final version.

  • Funding The study was funded by the Canterbury Distict Health Board.

  • Competing interests None declared.

  • Patient consent Not required.

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

  • Data sharing statement No additional data are available.

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