Gaps in the inpatient management of XXXX and impact of an evidence-based order set.

@entity1 @entity1211 @entity479 @entity1030
BACKGROUND: Evidence-based, guideline-recommended practices improve multiple outcomes in @entity1 admitted with acute exacerbation of @entity1030 (AECOPD), but are incompletely implemented in actual practice. Admission order sets with evidence-based diagnostic and therapeutic guidance have enabled quality improvement and guideline implementation in other conditions. OBJECTIVE: To characterize the magnitude of care gaps and the effect of order sets on quality of care in @entity1 with AECOPD. METHODS: The authors prospectively designed a standardized chart review protocol to document process of care and health care utilization before and after implementation of AECOPD order sets at an academic hospital in Toronto, Ontario. RESULTS: A total of 243 total AECOPD admissions and multiple important care gaps were identified. There were 74 admissions in the pre-order set period (January to June 2009) and 169 in the order set period (October 2009 to September 2010). The order set was used in 78 of 169 (46.2%) admissions. In the order set period, we observed improvements in respiratory therapy educational referrals (five of 74 [6.8%] versus 48 of 169 [28.4%]; P<0.01); @entity1211 prophylaxis prescriptions (when indicated) (15 of 68 [22.1%] versus 100 of 134 [74.6%]; P<0.01); systemic @entity479 prescriptions (55 of 74 (74.3%) versus 151 of 169 [89.4%]; P<0.01]); and appropriate antibiotic prescriptions (nine of 24 [37.5%] versus 61 of 88 [69.3%]; P<0.01). The mean (   SD) length of stay also decreased from 6.5  7.7 days before order sets to 4.1  5.0 days with order sets (P=0.017). CONCLUSIONS: Care gaps in inpatient AECOPD management were large and evidence-based order sets may improve guideline adherence at the point of care. Randomized trials including @entity1 outcomes are required to further evaluate this knowledge translation intervention.
