Improved discharge care for patients with COPD in Cornwall  

More people with Chronic Obstructive Pulmonary Disease (COPD) in Cornwall are receiving the right care when they leave hospital, thanks to a collaboration between the South West Academic Health Science Network and Royal Cornwall Hospitals NHS Trust to improve the implementation of discharge bundles for patients with the lung condition.  

Discharge bundles – a collection of evidence-based care practices put in place while a person is in hospital – can ensure the best outcome for patients when they go home.  

For patients with the condition COPD, a discharge care bundle comprises arrangement of follow-up care, checking of their inhaler technique, referral for smoking cessation support, assessment and referral for pulmonary rehabilitation, emergency drug pack provision, and provision of a self-management plan.  

Research has shown that implementing these bundles for patients with COPD results in fewer readmissions to hospital, with associated reduction in costs and implications for improved patient outcomes. [1] 

Since 2019 the South West Patient Safety Collaborative (PSC), hosted by the South West Academic Health Science Network, has worked with Royal Cornwall Hospitals NHS Trust (RCHT) to support the improvement of COPD and asthma discharge care bundle implementation in the region, as part of the (now closed) NHS England and NHS Improvement Adoption & Spread Safety Improvement Programme. 

Before our collaboration, a new Asthma & COPD Nurse service had been set up at Royal Cornwall Hospital during the pandemic by Respiratory Specialist Nurse, Jill Leyshon. Jill, who is passionate about improving patient care, had set up the service and was implementing the discharge bundles singlehandedly, despite the pressures from COVID-19.  

The South West AHSN provided ‘pump prime’ funding to the respiratory team, to support an audit facilitator to enter National Asthma and COPD Audit Programme (NACAP) audit data while Jill sourced substantive funding for their role.   

Says Jill: “[The South West AHSN funding an audit facilitator] enabled me to track and report on the progress of our new Asthma & COPD Nurse service. This data helped me to secure funding to grow the team with two additional specialist nurses.” 

Alongside this funding the South West AHSN also provided bespoke quality improvement support, including clinical leadership support, provision of learning events and webinars, and facilitation of networking across organisations within Cornwall and the wider South West region. 

The impact  

Since the project began in 2019, RCHT has seen a 46% increase in people with COPD receiving all elements of the bundle for which they are eligible.[2]  

• 54% more people [with COPD] have had appropriate follow-up care arranged on discharge 
• 51% more people have had their inhaler technique checked 
• 51% more people have been referred for smoking cessation support 
• 49% more people have been assessed for pulmonary rehabilitation 
• 42% more people have been provided with emergency drug packs 
• 34% more people have been provided with a self-management plan 

For Jill, the audit and audit facilitator have provided an opportunity to evidence the impact of their work.   

“Through the audit we have been able to demonstrate the impact on our service in terms of the increase in the percentage of COPD patients we see and who receive the discharge care bundle.” 

Explore our summary of the impact. 

While the Adoption & Spread National Patient Safety Improvement Programme closed in March 2022, RCHT continues to engage in ongoing improvement work as a member of the Kernow Respiratory Oversight Group and Southwest Respiratory Network.  

The South West AHSN is working on other respiratory-related projects through national programmes to improve access to Fractional Exhaled Nitric Oxide (FeNO) testing and asthma biologics. Learn more here.  

For more information about our work with RCHT on COPD discharge care, please contact South West AHSN Programme Manager, Victoria Salmon (victoria.salmon@swahsn.com).  

References 

[1] Ospina et al 2017: A systematic review of the effectiveness of discharge care bundles for patients with COPD | Thorax (bmj.com) 

[2] Data from National Asthma and COPD Audit Programme