Intervention type | ||||
Stage of AECOPD Care Pathway Impacted | Care bundle (eight articles) | Care pathway (six articles) | Coordinated case management (five articles) | Health coaching (two articles) |
Presentation29 30 36 Admission30 35 Discharge31–34 Presentation through to discharge36 | Admission through to discharge37–42 | Admission through to discharge46 Discharge planning43–45 | Admission through to discharge48 49 | |
Intervention elements | Multidisciplinary team design29–33 35 Initial assessment or investigation29 30 35 36 Initial treatment or medication29 30 34–36 Respiratory specialist consultation29–31 35 36 Patient education31–33 Discharge planning31–33 35 36 Specialist service referral (eg, smoking cessation, occupational therapy)29 31–36 Follow-up plan31–35 | Multidisciplinary team design37 40–42 44 Assessment/investigation at presentation40 Assessment/investigation at admission37 39 41 Initial or ongoing treatment/medication prompts37 38 40–42 Patient education38 40–42 Specialist service referral (eg, smoking cessation, occupational therapy)37–42 Discharge planning38–40 42 Postdischarge planning (hospice/palliative care)39 | Inpatient specialist visits44–47 Patient education43–46 Self-management strategies43 45 Postdischarge home visit43 44 Patient needs analysis43 44 46 Liaison with other specialists43–47 Ongoing telephone support44–47 Call centre support43 45 | Inpatient specialist visits48 49 Patient education48 49 Written information48 49 Personal health goals49 Self-management strategies (incl. exercise)48 49 Postdischarge home visit49 Ongoing telephone support48 49 |
Key disciplines involved in implementation | Nursing29–31 Physiotherapy31 Medicine30 31 33 34 36 Pharmacy31 33 | Nursing37 38 40–42 Physiotherapy37 38 40–42 Medicine37 38 40–42 Pharmacy42 Nutrition/dietician37 42 Social work37 40 Occupational therapy37 40 41 Palliative care39 | Designated coordinator (nurse or other)43–47 Primary care team (medical and nursing)43 44 46 Social work46 | Dedicated health coach48 49 Nurse specialist48 49 Respiratory therapist49 |
Methodology and supports for implementation | Model for Improvement (Quality Improvement)30 31 33 35 Audit29 30 36 Focus group/workshop/interview30 31 33 35 Patient input31 33 35 Staff education29–31 35 36 Posters30 Email reminders30 Worksheet/pack30 31 Pre-checked forms34 36 Staff “champion”30 Staff feedback/survey30 31 33 Commissioning incentives30 32 Inbuilt electronic system33 34 36 Awards/prizes31 | Model for Improvement (Quality Improvement)38 Audit38 41 Focus group/workshop38 41 Designated coordinator37–39 41 Staff education37 38 41 Discipline specific responsibilities37 40 Daily checks to identify patients37 Launch/promotion37 Peer to peer support37 Worksheet/pack39 42 | Specific training43 Dedicated case management role43 45 46 Patient/family engagement46 47 | Specific training48 49 Supervision49 Coaching session evaluation49 |
Key outcomes measured | Bundle adherence29–34 36 Length of stay32 33 36 Readmission rate29 31–33 36 Emergency department presentations36 | Pathway adherence38 39 41 42 Length of stay37 38 40 41 Readmission rate37–40 Complication rate37 40 Mortality37–39 41 42 | Emergency department presentations45 47 Readmission rate43–47 Quality of life43 44 46 Patient satisfaction44 Level of knowledge44 Mortality46 Length of stay45 | Readmission rate49 Quality of life49 Physical activity48 49 Health belief48 Self-efficacy48 Dyspnoea scores48 |
Some articles contain multiple PICO criteria in each category.
AECOPD, acute exacerbations of chronic obstructive pulmonary disease; PICO, population, intervention(s), context and outcomes.