|High need for Community care to support early discharge in patients admitted with Acute Exacerbation of COPD with a Low DECAF score in a level 3 hospital
|E.Burke Respiratory Nurse Specialist, A.Yunes Respiratory Registrar, H.McLoughlin Respiratory Consultant Respiratory Department, Portiuncula Hospital, Ballinasloe
|Portiuncula Hospital, Saolta Group
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|Asthma and COPD
|Dyspnoea, Eosinopenia, Consolidation, Academia and Atrial Fibrillation (DECAF) Score is a clinical prediction tool used in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The scores reflect in-hospital mortality risk. Scores of 0-1; low risk, 2; intermediate risk and 3-6; high risk. A prolonged hospital stay during an episode of AECOPD increases the risk of associated medical complications. Using the DECAF can guide appropriate early discharge from hospital to community follow up. Hospital admissions for exacerbation of COPD are a major cost to health services. Reducing length of stay (LOS) will reduce cost. The Health Pricing Office Annual Report in Ireland (2016) calculated the average LOS for COPD patients at 7days. The National Institute for Health and Clinical excellence (NICE) guidelines suggest that early discharge to appropriate community care can reduce the cost burden.
A retrospective study of patients admitted with AECOPD from June to December 2019 were examined. The DECAF score and LOS was calculated on each. A prolonged LOS was defined as greater than 5 days.
A total of 47 patients were included in this study. The average LOS calculated for this group was 5.92 days. Thirty nine of this group had a DECAF score of 0-1. The average LOS for low risk patients was 5.439 days. 38.4% scoring a DECAF of 0-1 showed a prolonged length of hospital stay.
More than one third of patients could have been discharged earlier if there was suitable services in our community.