P50 Piloting a standardised approach to management of patients with previously undiagnosed COPD presenting with exacerbations

IntroductionApproximately one third of people with a first hospital admission for a COPD exacerbation have no previous diagnosis.1 The Integrated Respiratory Team (IRT) consists of specialist nurses and physiotherapists and provides holistic reviews of patients with known COPD, prioritising high value interventions. Patients without a prior COPD diagnosis previously were directed to the respiratory registrar for review. Due to multiple commitments of the registrars a proportion of patients do not receive inpatient review and are discharged without follow up or initiation on inhaled therapy whilst awaiting formal diagnosis leading to discrepancies in care. Informal feedback from the IRT identified low staff confidence when reviewing these patients and concern about scope of practice.AimTo assess staff confidence in reviewing patients treated for an exacerbation of COPD without prior diagnosis and implement changes to increase staff confidence in reviewing these patients.MethodsStaff confidence was assessed using a questionnaire including a 0–100 numerical rating scale (NRS) and open questions to explore views on how their confidence could improve. Suggested interventions were subsequently implemented based on questionnaire results and the questionnaire repeated after to determine the effect of the interventions on confidence.Results13 staff were surveyed, mean NRS for confidence pre-intervention was 70% (range 50% to 100%). Analysis of how staff confidence could increase identified two themes, ‘staff training’ and ‘a guideline to support practice’.In response to the questionnaire, a Standard Operating procedure (figure 1) was developed and training programme implemented.The follow up questionnaire was completed by 11 staff. 84% reported increased confidence levels. Mean NRS for confidence increased by 7% to 77%. Staff were asked if anything else would help increase their confidence, one respondent identified teaching refreshers, and three further stated more clinical experience.Abstract P50 Figure 1ConclusionImplementing a SOP and training programme increased team confidence in reviewing patients with undiagnosed COPD. Overall improvement may have been limited due to COVID redeployment between both questionnaires. Facilitating the IRT to review this patient cohort improves patient access to specialist services and timely diagnosis and reduces variations in patient care.ReferenceNHS (2019). The NHS Long Term Plan. www.longtermplan.nhs.uk