Adherence to guidelines for COPD in an ED setting can help patients avoid compromising their health-related quality of life.


Evidence suggests that adherence to COPD guidelines in the ED can help avoid compromising a patient’s HRQOL.

However, “challenges in the acute clinical setting include a lack of a single integrated platform, supporting infrastructure, interdisciplinary staff capacity, lack of clinician training and support for underconfident clinicians to use digital devices, and a lack of critical information at point of care,” write Hancy Issac, PhD-candidate and colleagues in the International Journal of Chronic Obstructive Pulmonary Disease.

Cultivating Consensus on COPD Management

Given these obstacles to adherence, the study team sought to cultivate a consensus of information necessary to develop an electronic integrated COPD proforma (E-ICP) that improves COPD management in the ED. This digital resource would provide staff with consistent information based on up-to-date guidelines, the ability to make referrals with ease, patient resources, and staff training opportunities.

Issac and colleagues used a modified Delphi study method that allowed targeted experts (eg, ED and respiratory clinicians) to share their opinions and experiences in order to develop an actionable consensus that could be used in the E-ICP. The process began with an extensive literature review, and then the investigators applied a mixed-method design using electronic surveys that kept participants semi-anonymous. This first convened a panel to identify interventions that should be included in the proforma. The next portion of the study aimed to find consensus among the experts regarding the interventions they identified, which required three rounds of a quantitative survey that was scored to narrow in on agreement among the experts.

The results were analyzed and consensus on a topic was “considered reached if at least 70% of the panel strongly agreed that an item should be included or excluded from the proforma,” explain Issac and team.

Agreement among the expert participants was highest (more than 80%) when it came to addressing barriers to care. General concern existed over lack of resources, lack of sufficient time to provide care, and lack of clear direction regarding the referral process. There was also a positive response to the development of the electronic proforma. Participants believed that this type of standardized digital tool could help with efficiencies and the distribution of information.

Providing Consistent COPD Guideline Adherence

The iteration of surveys also revealed that although ED and respiratory staff did not initially agree on the application of referrals when a patient presented with COPD symptoms in the ED, they did eventually agree that a respiratory nurse serving as a single point of contact would be the ideal advocate to provide consistent guideline adherence potentially avoiding readmission or compromised care.

Issac and colleagues explained that an E-ICP based on the information gleaned from their modified Delphi study has the potential to ease the referral process, reduce hospital admissions rates and lengths of stay, provide a more complete approach to care, and increase utilization of, and adherence to, up-to-date COPD guidelines (Table). “This proforma will aid to resolve major barriers of knowledge, environmental resources, and professional role clarity in the management of COPD patients in the ED,” they wrote.