Standardizing Treatment for Acute Exacerbations of COPD (AECOPD) at a Large Academic Hospital

BACKGROUND: Acute exacerbations of COPD (AECOPD) are a common problem faced by patients with chronic obstructive pulmonary disease (COPD). There are discrepancies in AECOPD treatment that impact patient outcomes. Despite evidence of improved or non-inferiority outcomes and reduced cost with short oral regimens, steroid prescribing patterns remain variable. Furthermore, there is confusion regarding antibiotic choice that contributes to the problem. LOCAL PROBLEM: The local problem is the lack of standardization of care for AECOPD at Clements University Hospital (CUH). Data from 6/1/2021-5/31/2023 shows that AECOPD treatment at CUH has been variable despite the availability of evidence-based medications. AIM: The aim of this project is to improve the adherence to evidence-based selection of steroids and antibiotics for AECOPD at CUH by 75% at 1 year after the intervention along with a 10% decrease in length of stay and readmissions. METHODS: The intervention is an order set containing guidelines and treatments for AECOPD that can be implemented into Epic electronic health records. Emergency department physicians, hospitalists, and pulmonologists were consulted for insight about treatment recommendations. This advice along with the GOLD guidelines and additional research were used to create the order set. RESULTS: The order set is now ready for implementation into Epic after being presented to physicians and respiratory therapists for feedback. After implementation, data will be collected on the usage and effectiveness of the order set and analyzed for up to one-year post-intervention. CONCLUSION: AECOPD is a complex disease that is treated with various medications that can lead to the different outcomes. Insight from various physician specialties was helpful to understand methods at CUH at different stages of the AECOPD journey. Due to the complexity, the order set can be a helpful resource for physicians when choosing treatments to improve adherence to evidence-based medications and patient outcomes.