COPD hospitalisations place huge burden on EDs

People with COPD have high rates of unplanned hospitalisations that are hugely expensive and divert funding from services that could be better provided in the community, a Queensland study has found.

The average cost of a hospital stay for people with COPD admitted from emergency department was $8297, according to an analysis of presentations for 5253 COPD patients at three hospitals covering the Ipswich, Toowoomba and the Gold Coast regions.

The study, carried out between 2017 and 2018, found that most people with COPD (83%) who presented at EDs were self referred or referred by family and friends, but many had only a brief stay.

More than half the patients (52%) were discharged from the ED within four hours, regardless of triage category, in contrast to the average length of stay of almost seven hours across all ED presentations.

The main factors associated with hospital admission were triage category and increasing age, with the average age of patients being 78 years and a majority of patients having had more than one ED presentation during the 20-month study period.

For patients who were admitted to hospital, 17.7% had a length of stay (LOS) of 2-3 days, 10.5% had a LOS of four to five days and 18.5% had a LOS of more than five days.

The total cost of COPD admission for the three hospitals was $42 million during the study period, with an average cost per admission of $8297.

“This large number of unplanned admissions places more pressure on EDs that are already experiencing high  caseloads,” said the study authors in their paper published in Emergency Medicine Australasia.

“This situation significantly increases the costs of treating COPD patients who could be diverted into less expensive treatment modes (stepped care) especially within primary health care.”

The authors said COPD patient presentation to ED and admission to hospital was an expensive method of providing healthcare to manage a chronic condition, especially as patients seemed to be presenting multiple times.

“Clinical practitioners and policy makers need to develop and implement optimal integrated care management systems to reduce this hospitalisation rate and reduce the societal costs associated with COPD patient management,” they suggested.

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