Reducing length of stay for patients hospitalized with exacerbation of COPD by using a practice guideline

Clinical practice guidelines have been promoted as an effective way of reducing costs while maintaining quality care. Objective: To study a practice guideline to shorten length of stay for patients hospitalized with exacerbation of COPD. Methods: We retrospectively studied a practice guideline to identify patients who were at low risk of complications from their exacerbation of COPD and hence potentially suitable for early hospital discharge. We then prospectively studied the practice guideline using an alternate month intervention and control time series over a period of 12 months. Results: The practice guideline was retrospectively studied in 250 consecutive patients hospitalized with exacerbation of COPD. Of the 250 patients, 237 patients (94.8%) were classified as low risk after 72 h of hospitalization and were potentially suitable for discharge. In the prospective study, few patients (24 of 124 or 19%) were identified for implementation of the guideline. However, in those patients who were identified, length of stay was not statistically different. The data also showed that length of stay for both intervention and control groups had shortened over this time. Conclusion: Certain practice guidelines may appear efficacious in studies but may actually lack effectiveness when applied in clinical settings and may even increase costs. We demonstrated the importance of prospectively evaluating clinical practice guidelines before recommending them for widespread implementation.