Ensuring a robust pathway for COPD diagnosis for people admitted to hospital with suspected COPD - a quality improvement project. (ID 441)

L Clinch, Z Hawksley, T Ward, Houchen-Wooloff, L, Gardiner N

Leicester Hospitals

Funding: none

Abstract

Introduction
The diagnosis of Chronic Obstructive Pulmonary Disease (COPD) requires spirometric evidence of airflow obstruction. Access to spirometry reports during hospital admissions is variable and as a result, patients frequently receive a clinical diagnosis of COPD without spirometry confirmation. This may result in inappropriate prescription of inhaled medications and failure to recognise other treatable pathology.
Aims:
• To increase referrals for out-patient diagnostic spirometry for patients with suspected COPD
• To review the outcome of spirometry testing
• To investigate the use of inhaled medicines in those without airflow obstruction
Methods
The COPD Specialist Nurses reviewed patients with a suspected diagnosis of COPD during their admission to hospital. If spirometry was available, the nurses added this to the patient paper record. If spirometry could not be located, an outpatient spirometry request was made. The nurses reviewed the outcome of spirometry referrals and the inhaled medicines prescriptions.
Results
A sample of 200 patients clinically diagnosed with COPD as in-patients and referred for out-patient spirometry were randomly selected from a sample of 549 hospitalised between April 2021 and November 2022.
Of 200 patients referred, 110 attended for spirometry, 90 did not, and it was discovered that there had been an issue sending out invitation letters which has subsequently been overcome. Of those tested, 39% failed to meet the criteria for airflow obstruction and of those, 79% were in receipt of inhaled medicines.
A pathway was created and medical staff were asked to diagnose as ‘likely’ or ‘probable’ COPD until the clinical diagnosis could be confirmed with spirometry.
Conclusion
Clinical diagnosis of COPD during hospital admission without spirometric confirmation leads to significant over diagnosis and inappropriate prescription of inhaled medication. A robust pathway ensures timely test requesting to modify treatment and investigate for other causes of symptoms if necessary.

Conflicts of interest: none

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