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 ratesOECD

COPD hospital admission ratesOECD

Admissions to ChCh hospital for COPD – milder disease increasing

ED attendance mode for admitted COPD patients

COPD admission day of weekCo

unt

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

Month Season Kept at Home(Acute Demand)

GP 24 Hour Surgery

ED 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%

Nov Summer 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%

COPD Ambulance Numbers(1st July 2012 – 1 March 2013)

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

Microsoft Word Document