Variabilidad en la atención del paciente con exacerbación EPOC en urgencias hospitalarias de la Red SACYL

Abstract

OBJECTIVES. Assess the degree of implementation of action protocols for managing exacerbated chronic obstructive pulmonary disease (COPD) in hospital emergency departments (EDs) in Castilla y León, and evaluate access to logistical and therapeutic resources. MATERIAL AND METHODS. Cross-sectional, descriptive study based on a 27-item multicenter email survey of hospital EDs in the Spanish autonomous community of Castilla y León. Univariate and bivariate analyses were applied to the responses. Absolute and relative frequency tables were constructed for categorical variables and hospital classifications. Contingency tables were constructed for continuous variables; we calculated means as well as medians and ranges for nonnormally distributed data. The Fisher and Kruskal-Wallis tests were used to explore associations between categorical variables according to hospital classification. RESULTS. Fourteen hospital EDs participated in the research network (100% of all hospitals in the region). No action protocol for exacerbated COPD was in use in 6 hospitals (42.9%). In 7 hospitals, management of exacerbated COPD was led by the emergency department (vs Neumologist or internists). In 10 hospitals (71.4%), no specialist in acute respiratory disease was available. No regular meetings to evaluate, update, or monitor the management of exacerbated COPD were held in 42.9% of the EDs; occasional meetings were held in the remaining hospitals. Thirteen of the 14 EDs had access to noninvasive mechanical ventilators. The ventilators were used routinely as the first line of treatment in 42.9% of them. In 35.7% they were used sometimes, and in 21.4% they were not used. CONCLUSIONS. The findings revealed great variability in access to medications, action protocols, referral to specialists, and management of exacerbated COPD among the hospitals in Castile-León. Although these hospital EDs have an essential role to play in the care pathway for managing COPD exacerbations, they should take steps to unify criteria and create consensus-based guidelines for managing exacerbations.