Implementing Early supported discharge, Chronic Obstructive Pulmonary Disease, Community, Primary care, Multidisciplinary team, Change management, Kotter's 8-step Model.

Abstract

Aim: The purpose of this paper is to
present the development and implementation of
Early Supported Discharge (ESD) for those
patients admitted to hospital with an acute
exacerbation of chronic obstructive pulmonary
disease (COPD). It also outlines the
collaboration between secondary and primary
care using Kotters 8-step change model.
Background: Acute exacerbation of chronic
obstructive pulmonary disease (COPD) accounts
for 1:20 emergency admissions daily, 500 of
which are admitted spending an average of 6.5
days in hospital. Alternatives to managing
exacerbation of COPD in a hospital setting were
first suggested by the Royal College of Physicians
in 1981. Emergency admissions for COPD place
a significant burden on the resources of the NHS.
Methods: Kotters 8-step model of change was
used in this study. All adult patients (55 years or
older) admitted to the Acute Medical ward with
an exacerbation of COPD were assessed for their
suitability for ESD. The period of the study was
from February to June 2011. The service was
operational from Monday to Thursday, and
between the hours of 09.00 and 12 midday.
Patients admitted with the diagnosis of COPD
were identified by;
• Accessing admissions information via a
hospital information system
• Referral from nurse in charge of
admissions ward
• Referral from Doctors.
Results: The approach adopting a change model
has resulted in a period of six months 27 patients
being discharged under the ESD scheme. Only
one patient was readmitted within 30 days.
Conclusion: Approaching the change in smaller
steps encourages reflection and development of
leadership skills, and analysing the small steps
allowed the development of a clear strategy
which moved ESD forward. This service
development has been a very positive experience,
in the main due to the collaboration between the
Respiratory Nurses and COPD Team.