“It's not about the
physiology”
During 2011 COPD in Christchurch
accounted for:
1,256 admissions (3.5 per day)
5,952 bed days (two wards in winter)
1 in 4 being readmitted within 28 days
4 out of 5 arriving by ambulance
Diabetes hospital admission rates
OECD
COPD hospital admission rates
OECD
Admissions to ChCh hospital for
COPD – milder disease increasing
ED attendance mode for admitted
COPD patients
COPD admission day of week
800
17%
737
15%
660
700
15%
676
14%
619
15%
657
600
14%
605
12%
514
Count
500
400
300
200
100
0
Mon
Tue
Wed
Thu
Day of Week
Fri
Sat
Sun
ED attendance with Resp. disease
(>85% admitted)
09:00 – 17:00
The Tsunami of COPD
• All these people in hospital are there because
there are more people out there, all getting
worse
• We need more beds to cope
• People come to hospital with COPD after
hours
What were we trying to change?
• Patient response – how to stay well
• Ambulance responses - assess severity by agreed
criteria, knowing patient prior status
– Call practice if well
– Involve Acute Demand / 24 hour surgery if less well
– Severe exacerbations or uncertain – ED
• ED and AMAU responses – consider early supported
discharge – ADMS or CREST
– Acute Demand nurses in ED and AMAU
– Enhance Acute Demand skill to treat COPD
• Visibility of patient history / plan through technology
CCMS & eSCRV
Outcomes
• Count of Acute Admissions
• ED Attendances (Total and those brought by
Ambulance)
• Occupied bed days
• % of patients admitted
COPD admissions last 105 weeks
Bed days last 105 weeks
Bed days E65B last 105 weeks
E65B Admissions last 105 weeks
COPD Ambulance Numbers
(1st July 2012 – 1 March 2013)
Month
Season
Kept at
Home
(Acute
Demand)
GP
24
ED
Hour
Surgery
Total
% In
Primary
Care
July
Winter
2
4
38
186
230
19%
August
7
62
16
116
201
42%
Sept
11
60
14
128
213
40%
October
8
57
18
114
197
42%
2
28
11
102
143
27%
Dec
3
23
7
83
116
28%
Jan
5
21
4
109
139
22%
Feb
6
30
10
81
127
36%
Nov
Summer
Eye Openers…….
•
•
•
•
System Response
The numbers!
Ambulance
Primary Care GP response
Lessons Learned……
• Education / communication / engagement
• Keeping it simple
• What does success look like?
Winter of 2013...
•
•
•
•
More of the Same
Meetings with Ambulance ramping up
Risk stratification / use of Med’s database
Joined up response - CREST – hospital and
community
• Additional links with the MDT