Chronic obstructive pulmonary disease exacerbations (COPDE) are frequently overtreated with antibiotics. In April 2014, a clinical pathway for COPDE was released as part of our Antimicrobial Stewardship Program (ASP) at The Ottawa Hospital (TOH). TOH is an 1100-bed, tertiary-care institution in Ottawa, Canada, with acute care beds distributed over two geographically distinct campuses.
To determine if:
1) The clinical pathway (intervention) resulted in improved antibiotic prescribing
2) Patients treated as per the pathway had different readmission rates for pulmonary infections or COPDE compared to patients who were not
A retrospective chart review of patients
admitted with a COPDE between September 2013 to December 2013 was performed,
and compared to COPDE admissions between September 2014 to December 2014 for
appropriateness of antibiotic use, agent and duration as defined in the COPDE
pathway. Readmission rates for patients treated or not treated according to the
pathway were also assessed. Charts were excluded if there was concomitant
pneumonia, a second admission under the same service within the same 4-month
time period, or if the patient's condition was not covered by the pathway
(e.g., cystic fibrosis). Services selected were internal medicine, family
medicine, respirology and the intensive care unit.
45 pre-intervention charts and 45 post-intervention charts were reviewed. Overall, only the choice of agent improved after the implementation of the clinical pathway. Due to a lack of resources, stewardship rounds were not performed at Campus B from mid-October to December 2014 which may explain the difference in findings between campuses.
Overall, regardless of the time period, 7/53 (13%) patients treated according to the pathway were readmitted within one month of discharge for a COPDE or a pulmonary infection compared to 6/37 (16%) who were not treated according to the pathway.
This retrospective chart review suggests that a clinical pathway, in conjunction with active promotion by the ASP, helps improve antibiotic management of COPDE. Treating according to the pathway did not result in an increase in readmission rate.
V. Roth, None
S. Bui, None
A. Ling, None
K. Suh, None