For World COPD Day, our Senior Improvement Lead Jose Garcia Escudero looks at some of the wider contexts in relation to chronic obstructive pulmonary disease (COPD) and current work being undertaken in the East Midlands to improve patient safety of those living with the condition.

The British Lung Foundation describes chronic obstructive pulmonary disease (COPD) as “a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed”. COPD can be treated but not cured and its seriousness should not be underestimated.

It is estimated that 3 million people in the UK are affected with COPD. This makes it the second most common lung disease in the UK following asthma. The estimated annual cost of COPD to the NHS is £1.9 billion.

Health inequalities and COPD

The British Lung Foundation highlights the strong links between lung disease, deprivation and health inequalities:

In those communities with the highest levels of deprivation, lung cancer and COPD are considerably more common. Whilst smoking is the leading cause of COPD, this is an especially strong factor in these communities. Outdoor air pollution is generally higher in deprived urban areas. There are links between the development of lung disease and the worsening of its symptoms. Poor housing and homelessness is linked to respiratory disease. Work skills and qualifications influence in some cases the exposure to occupational hazards that may result on breathing or lung problems (15% of COPD cases result of workplace exposure to dust and chemicals).

This is important context when considering the prevalence of COPD in the UK and in the East Midlands and highlights the need to address such health inequalities. In the Marmot Review, Fair Society, Healthy Lives, Michael Marmot says “Knowing the nature and size of the problem and understanding what works to make a difference must be at the heart of taking action to achieve a fairer distribution of health.” I would agree with this and I think it is everyone’s responsibility to understand and make a conscious effort to recognise the factors that contribute to chronic conditions where patient safety is compromised.

According to Public Health England in 2017/18, in the East Midlands, there were 437 COPD related Emergency Hospital Admissions to every 100,000 people – above the average for England overall which was 415 to every 100,000 people. There was also a disparity across the county with the highest amount of admissions in the cities of Nottingham and Leicester (723 and 624 per 100,000 people respectively) and the lowest in the county in Rutland (215 to every 100,000 people).

As a Patient Safety Collaborative (PSC), we want to support healthcare providers across the East Midlands region to improve care and outcomes for COPD patients.

Spreading best practice across the East Midlands

As part of the adoption and spread workstream of the PSC’s National Patient Safety Improvement Programme, our aim is to facilitate the spread of proven best practice initiatives for increased patient safety.

For COPD we are working with trusts across the East Midlands to spread the British Thoracic Society (BTS) COPD Discharge Care Bundle. The bundle acts as a prompt for healthcare professionals to ensure some key actions are completed for each patient. These high impact actions ensure the best clinical outcomes for patients admitted with an acute exacerbation of COPD. The bundle aims to ensure that all aspects of care are considered and to reduce hospital readmissions for these patients.

Our work is not just to encourage the use of the COPD Discharge Care Bundle but to help NHS trusts that are already applying it to continually improve processes to enhance the safety of patients living with COPD.

The COPD Discharge Care Bundle was originally trialled by Kent, Surrey and Sussex AHSN and from 2014-2018 there was a significant downward trend in both length of stay (6.2 to 5.5 days) and hospital mortality (4.7% to 3.4%) across that region.

Encouraging the adoption and spread of proven patient safety initiatives helps us to work collectively to improve patient safety for some of the UK’s most prevalent long term conditions, like COPD. By embedding a culture of reflection and striving for continual improvement, we can help healthcare providers make sustained progress towards benefiting patients and the wider health and care system. For me, the key message I’d like as a takeaway from World COPD Day is that we need to welcome change and work together to make continual improvements – which is very much the ethos behind this year’s ‘all together’ strapline for the World COPD Day campaign.

Author

Jose Garcia Escudero, Senior Improvement Lead