Study: Checklist ticks off days from COPD hospital stays

Patient care checklists can help improve patients with worsening chronic obstructive pulmonary disease (COPD), according to a study published in the Canadian Respiratory Journal.

COPD is the fourth leading cause of death globally and is the leading cause of hospitalization in Canada.

The study, the first to examine the impact of evidence-based checklists on patients with COPD, found that these patients spend less time in the hospital when their doctors manage their care by using a checklist of steps called order sets.

As part of the study, investigator Samir Gupta, a pulmonologist at St. Michael’s Hospital, Toronto, Ontario, Canada, and colleagues, encouraged physicians and staff to use an order set for all patients admitted with worsening COPD. Developed by a team from the respirology and internal medicine wards at St. Michael’s, the order set provided comprehensive admission instructions.

Gupta

“The main findings were that the order sets resulted in a significant drop in the length of hospital stay, and also resulted in a significant improvement in several ordering behaviors,” Gupta tells Medical Economics.

“Pre-formatted order sets for the care of hospitalized acute exacerbation of COPD, when used in paper or electronic format, can successfully influence ordering behavior to improve adherence with best practices, which may in turn lead to improved patient outcomes and decreased length of hospital stay,” he says.

When the order set was used, patients’ length of stay in the hospital fell by about two-and-a-half days.

“We were confident that the order sets would improve ordering behaviors, but we were surprised that in the context of a small study such as ours, and given the fact that the patients seen in the order set period had generally more severe COPD, that we were able to demonstrate a statistically significant reduced length of stay for patients in the order set period,” Gupta adds.

In addition, the study found that order sets increased the proportion of patients who were prescribed corticosteroids, which can help keep COPD patients out of the intensive care unit by controlling the inflammation in their lungs.

More patients also received the correct antibiotics, which means that order sets can lead to less overtreatment and ultimately may lead to less antibiotic resistance.

“It is well documented that [computerized physician order entry] systems reduce medication-related ordering errors-dosing errors, drug interactions, etc.,” Gupta says. “However, this builds on that by demonstrating that embedded decision support as part of a comprehensive disease-specific order set might improve a myriad of best practices across inpatient medicine. The potential here is far beyond ensuring the right dosage and reducing drug interactions by providing decision support at the point of ordering. Decision support might actually be able to influence which drugs doctors order, bringing these medication orders in line with best evidence.”