Reorganisation of acute referral to an emergency department resulted in fewer admissions for chronic obstructive pulmonary disease but in higher rates of non-invasive ventilation.

INTRODUCTION: We performed an audit on all admissions with chronic obstructive pulmonary disease (COPD) in ex-acerbation to the Department of Emergency Medicine, Odense University Hospital (DEM) in the second half of 2012 to evaluate if an organisational change had altered visitation, treatment, initiation of non-invasive ventilation (NIV) and monitoring. We chose not to include the entire year to avoid data influenced by organisational start-up difficulties. The hypothesis was that NIV was initiated according to guidelines to the same extent as prior to the implementation of DEM. METHODS: Data from medical records were retrieved from two COPD cohorts: 1) all patients admitted to DEM between 1 July and 31 December 2012 and 2) all patients admitted to the Medical Emergency Ward, Odense University Hospital (MEW) in 2010. RESULTS: There were 300 eligible admissions comprising 236 unique patients in DEM in the second half of 2012 compared with 393 admissions in MEW in the second half of 2010, a 24% reduction. The groups were similar in gender and age, but patients admitted in 2012 had higher registered co-morbidity rates, but no significant difference in lung function values. NIV was indicated in 91 admissions (30%) and initiated in 58 admissions (19.3%) in 2012. By comparison NIV was indicated in 193 admissions (24%) and initiated in 151 admissions (18.8%) in 2010. CONCLUSION: There was a statistically significant increase in NIV indication without initiation of treatment in 2012 (28 admissions; 9.3%) compared with 2010 (36 admissions; 4.5%), but no referrals to the intensive care unit or deaths were registered during the hospitalisation in either of the groups, but one patient died within 30 days after admission from the DEM. FUNDING: This project was funded by an Odense University Hospital research grant. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency (record no. 2011-41-6459).