Improving Inpatient Care for Acute Chronic Obstructive Pulmonary Disease Exacerbations: A Quality Improvement Initiative

Abstract

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) account for high hospital use; guideline-concordant diagnostics, oxygen titration, and discharge planning are often under-delivered. We aim to measure baseline compliance with eight AECOPD process standards and evaluate whether EHR-embedded prompts plus staff education were associated with observed improvements.

Methods: We audited 50 consecutive adult admissions with primary AECOPD (ICD-10 J44.1 or clinician-documented diagnosis) between July and October 2024, implemented EHR prompts, an orderset, and targeted education (Nov–Dec 2024), then re-audited 50 consecutive admissions (Jan–Mar 2025) using identical methods. Primary process measures were pre-specified; analyses were descriptive with 95% Wilson confidence intervals (CIs) for proportions and two-sided Fisher exact tests for pre/post comparisons. This work was performed as a service evaluation/pilot.

Results: After implementation, six of eight process standards showed observed increases. Pulmonary rehabilitation referrals rose from 32/50 (64.0%, 95% CI 50.1–75.9%) to 43/50 (86.0%, 95% CI 73.8–93.0%), p = 0.0198. Oxygen titration improved from 40/50 (80.0%, 95% CI 66.0–88.6%) to 46/50 (92.0%, 95% CI 78.6–95.7%), p = 0.148. Other measures (ABG timing, bronchodilator and corticosteroid delivery, appropriate antibiotic use, CXR timing, smoking advice) showed observed improvements; p-values and CIs are reported in the text.

Conclusions: Embedding guideline-aligned prompts and an orderset in the EHR, together with staff education, was associated with observed improvements in several AECOPD process measures in this pilot QI project. Findings should be interpreted cautiously, given the pilot design, multiple comparisons, and limited sample size; further controlled and longitudinal evaluation is indicated.