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Respiratory Care Bundles
Professor Thida Win
Lister Hospital
[email protected]
BTS (British Thoracic Society)
Care Bundle Project
 November 2012 - December 2013
 21 NHS Trusts in England and Wales
 a care bundles-based approach to quality
improvement in the care of patients admitted to
hospital with an acute exacerbation of COPD
(AECOPD) and Community Acquired Pneumonia
1,438 bundles were used
 High level data
 11,748 patients admitted with AECOPD
 14,451 patients admitted with CAP
 Patient level data on processes and outcomes of care
 3,266 COPD admissions
 2,563 CAP admissions
 use of a care bundle was associated with a reduction in 30
day in-patient mortality from CAP from 13.6% to 8.8%.
 The presence of an oxygen prescription was also associated
with a reduction in length of stay for those with COPD
 COPD admission bundle with outcomes of care
demonstrated a statistically significant reduction in
mortality from AECOPD in patients
 in whom oxygen was prescribed at admission (OR 0.22 95%CI
 and in patients in whom care was delivered within 4 hours of
admission (OR 0.60 95% CI 0.42-0.87)
 This is the first time that use of a COPD bundle has been
associated with a reduction in in-hospital mortality!
Care Bundle Components
 COPD Care Bundle (Acronym: DARTS)
Assessment (for oxygen)
Recognition (of acidosis)
Timely medications
Specialist review
Care Bundle Components cont..
 COPD Discharge Care Bundle (Acronym: TAPSS)
Technique (inhalers)
Action plan
Pulmonary rehabilitation
Smoking Cessation
Specialist follow-up
Care Bundle Components cont..
 Pneumonia Care Bundle (Acronym: COST)
Chest x-ray (CXR)
Oxygen (assessment)
Severity (Scoring)
Timely & appropriate treatment
EoE Care Bundle Survey
 14/15 Trust replied
 4 Trusts not using Care Bundles at time of survey, but 1 was
 Majority (9) use a COPD discharge-bundle
 1 uses admission and Pneumonia bundle (KL)
 3 use asthma bundle addition to discharge bundle (Add/
 1 use pneumonia and admission bundle addition to discharge
bundle (JP)
 2 on Respiratory wards, 2 at MAU and 10 at All
Trusts not using Care Bundles
 L&D
 Princess Alexandra (Harlow)
 Peterborough
 3 Trusts achieved >90% use of discharge bundle
 Southend
 West Herts
 E&N Herts
 Help readmissions
 25% reduction in readmission (Ipswich)
 Some found difficult to say specific benefit due to
partial effects- pathway, specialist review, education,
staff change over etc
Barriers to implementation
CQUIN will ensure delivery of care bundle
 Care Bundles effective in improving reliability and reducing
unwarranted variation in care
 Wide implementation of Care Bundles is feasible
 Evidence suggested CAP, and COPD admission bundle
shows mortality benefit
 Emergency Oxygen prescribing & timely care essential
 Value of Clinical Specialist Leadership to ensure success
 Most EoE Trusts use care bundles, but uncertainty of their
components and outcomes