{
  "abstract": "Introduction Discharge bundles consist of a short list of evidence-based practices to be implemented prior to hospital discharge to optimise patient outcomes, address high COPD readmission rates and ensure consistent provision of high-quality care. However, despite the availability of evidence-based interventions, discharge bundles have been implemented with varying success.Methods The National Respiratory Audit programme (NRAP) is a continuous national audit of secondary care across England and Wales. Data from the 2023–2024 NRAP audit on COPD admissions were evaluated, and patients were included in this analysis if they were admitted with an acute COPD exacerbation and were alive on discharge (n=62,790). All elements of the discharge bundle were assessed for completion, and data were linked to demographic factors and compared nationally.Results The NRAP data report that delivery of the discharge bundle is a key performance indicator (KPI) in the COPD workstream and must be completed in 60% of patients admitted with an exacerbation of COPD to achieve the best practice tariff in England. However, only 28% of admissions nationally receive all elements of the discharge bundle. Performance across 171 hospitals ranges from 0–100%, with a median of 14.5% (IQR 1.3–42.8%). The audit data highlight a discrepancy between reporting delivery of the discharge bundle as a whole and confirmation of the delivery of each individual element. Assessment for pulmonary rehabilitation (PR), one of the most evidence-based interventions in COPD, was completed in only 57.8% (IQR 25.0–80.0). Completion of each discharge bundle element varies nationally, with a trend towards Integrated Care Systems (ICSs) in areas of higher deprivation reporting lower percentages of patients receiving fully completed discharge bundles ( figure 1).Abstract S7 Figure 1Variation in completion of the discharge bundle elements across England and Wales with integrated care systems (ICS) ranked by % of completed of elements. Note: Wales is shown as a national total rather than broken down by health board due to the small numbers associated with discharge bundle completion. Map created by NRAP team with Datawrapper.Conclusion Despite evidence supporting the use of discharge bundles in the care of patients with acute COPD exacerbations admitted to hospital, delivery of these evidence-based interventions remains variable, particularly in areas of high deprivation. Our data mirror findings from the recent Asthma + Lung UK ICS Respiratory Review 2024/2025,1 which highlights the same regions as having some of the highest rates of respiratory admissions and deaths.Reference Asthma + Lung UK (2024/2025). ICS Respiratory Review. Retrieved 10th March 2025, http://www.asthmaandlungUK.org.uk/healthcare-professionals/ics-respiratory-review",
  "authors": [
    {
      "affiliations": [
        "University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "H Burke"
    },
    {
      "affiliations": [
        "Imperial College London, London, UK"
      ],
      "name": "AJ Adamson"
    },
    {
      "affiliations": [
        "NRAP, Royal College of Physicians, Liverpool, UK"
      ],
      "name": "J Henderson"
    },
    {
      "affiliations": [
        "Imperial College London, London, UK"
      ],
      "name": "JK Quint"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "JW Dodd"
    },
    {
      "affiliations": [
        "University of Southampton, Southampton, UK"
      ],
      "name": "TMA Wilkinson"
    },
    {
      "affiliations": [
        "Kings College London NHS Foundation Trust, London, UK"
      ],
      "name": "I Patel"
    }
  ],
  "title": "S7 National respiratory audit programme (NRAP) highlights variation in delivery of discharge bundles of evidence-based interventions in patients admitted to hospital with COPD exacerbation",
  "uid": "764ffefb-b0e4-5a51-b13d-c2a1b4d6cb01"
}