1

The Implementation of a

COPD Discharge Care Bundle:

Why, How and Who?

Louise Sewell

Clinical Lead for Pulmonary Rehabilitation

& COPD Nurse Specialists Services

Who? Why?

When? How?

2

Why?

3

Care bundle

UHL Local CQUIN

2012-13

COPD

Care

Bundle

Why?

• CLAHRC Rehabilitation

Implementation team – managed by

Sally Boyce

• Established team of COPD specialist

nurses – REDS team

• Busy Pulmonary Rehabilitation team

already providing post exacerbation

PR

• SPACE manual developed on site

• Supported by NHS Improvement

Lung team and COPD Network

Who?

4

Sept 2011

•Set up task &

finish group –

meet regularly to

discuss process,

paperwork and

implementation

May ’12-Mar 13 Jan 2012

•Contents of

bundle agreed

•Changes to

REDS team

management

•Staff SPACE

training begins

April 2012 Feb 2012

•REDS team

begin to pilot

bundle

•REDS team

deliver

bundle to all

their patients

• Local

£960000

CQUIN

commences

•COPD

transformational

funding

•6 and 9 month

data analysis

Implementation phase Operational phase

When?

5

COPD Care Bundle Process

Stage 1

Care Bundle delivered by REDS

prior to discharge

Stage 2

Post discharge phone calls by REDS@

2 days and 15 days

Stage 3

Assessment for Pulm Rehab

within 4 weeks of discharge

So where are we?

137127

1059392

78

99

10

49

8590

0

20

40

60

80

100

120

140

160

Mar

chApril

May

June

July

August

Septe

mber

October

Novem

ber

Decem

ber

January

# p

ts r

ecei

ved

car

e b

un

dle

Total to date = 965

6

REDS Care Bundle Data: Number of phone calls received per patient

0

10

20

30

40

50

60

70

0 1 2 3 4 5 6 7 8 9 10

# phone calls per patient

%

Q1 Q2 Q3

COPD Care Bundle Data: Smoking Status

7

COPD Care Bundle Data: Referrals to smoking cessation services

COPD Care Bundle Data: Referral to Pulmonary Rehabilitation

6

28

51 53 46 58 62

5373

0%

20%

40%

60%

80%

100%

AprilM

ayJu

neJu

ly

August

Septe

mber

October

Novem

ber

Decem

ber

missing data

not appropriate

declined

completed

8

Mean number of Pulmonary

Rehabilitation referrals per month

64 69

104

0

20

40

60

80

100

120

2010-2011 2011-2012 2012-2013

refe

rral

s (n

)

COPD Care Bundle Data: Length of Stay

2011-12 2012-13

9

COPD Care Bundle: patient feedback.

“I’m grateful for the support

and I’m going through the

SPACE manual with a fine

tooth comb, very helpful.”

Mrs M, aged 61

“I think the service you

provide is marvellous, I have

learnt so much from my

admission and feel more

confident with the

management of my COPD.”

Mr C, aged 74

“The information is very

good and well written but

I feel it should have been

done years ago as I feel

it’s too late for me but will

benefit lots of other

younger people with my

condition.”

Mr S, aged 82

“I think the service is

really helpful and the

SPACE book is

excellent…I have bought

some weights and am

using them three times a

week as it tells you to in

the book.”

Mr S, aged 82

Summary

• There is a more streamlined and efficient pathway in

place for all patients with COPD.

• The impact upon length of stay and readmissions

currently being explored.

• This is now being delivered to over 70% of COPD

discharges from Glenfield.

• Referrals to smoking cessation and pulmonary

rehabilitation are significantly increased.

10

Thanks…