PP20 EFFECTIVENESS OF COPD DISCHARGE CHECKLIST IN REDUCING 30-DAY READMISSION: A SINGLE-CENTRE OBSERVATIONAL STUDY

Chee Kuan Wong, Shu Qing Sim, Nicholas Jian Shen Ng, Chiong Kian Tiong.

Universiti Malaya, Kuala Lumpur, Malaysia.

Introduction
The 30-day readmission rate for chronic obstructive pulmonary disease (COPD) patients is approximately 20% in both the USA and Malaysia, posing a significant healthcare burden. A systematic review of 14 studies demonstrated that discharge care bundles effectively reduce COPD readmissions, leading to expert recommendations for implementing evidence-based hospital discharge protocols.

Objectives
To evaluate the efficacy of a structured COPD discharge checklist in reducing 30-day readmission rates following acute exacerbations of COPD (AECOPD).

Methodology
This single-centre observational study was conducted at Universiti Malaya Medical Centre (UMMC), where an inpatient COPD nurse educator counselling service has been available since January 2020. A comprehensive discharge checklist was developed by the Respiratory Unit, covering key components of COPD care: smoking cessation, pulmonary rehabilitation referral, treatment optimisation, and post-discharge continuity of care. The checklist was implemented for patients admitted with AECOPD from June 2024 to April 2025. Data on demographics, clinical parameters, and 30-day readmissions were collected for all COPD index admissions from January 2024 to April 2025. Readmission rates before and after checklist implementation were compared, with risk ratios referenced against Kee YS et al., 2019.

Results
Among 152 index admissions, 55 occurred pre-implementation and 97 post-implementation. The majority were male (93.4%), with a mean age of 72 years. About 28.9% had elevated blood eosinophils, and 55.9% lacked prior spirometry assessment. Checklist implementation increased pulmonary rehabilitation referral and participation. When combined with nurse educator intervention, the checklist resulted in a 98.6% reduction in 30-day readmissions (RR 0.014, 95% CI 0.250-3.881), and a 35% reduction (RR 0.65, 95% CI 0.151-0.900) compared to standard care alone.

Conclusions
A structured COPD discharge checklist, integrated with nurse educator and pulmonary rehabilitation interventions, is an effective strategy to reduce COPD readmissions.