Implementation of multidisciplinary care reduces maternal mortality in women with sickle cell disease living in low‐resource setting

Sickle cell disease (SCD) is associated with adverse pregnancy outcome. In women with SCD living in low‐resource settings, pregnancy is associated with significantly increased maternal and perinatal mortality rates. We tested the hypothesis that implementing a multidisciplinary obstetric and hematology care team in a low‐resource setting would significantly reduce maternal and perinatal mortality rates. We conducted a before‐and‐after study, at the Korle‐Bu Teaching Hospital in Accra, Ghana, to evaluate the effect of a multidisciplinary obstetric‐hematology care team for women with SCD in a combined SCD‐Obstetric Clinic. The pre‐intervention period was assessed through a retrospective chart review to identify every death and the post‐intervention period was assessed prospectively. Interventions consisted of joint obstetrician and hematologist outpatient and acute inpatient reviews, close maternal and fetal surveillance, and simple protocols for management of acute chest syndrome and acute pain episodes. Primary outcomes included maternal and perinatal mortality rates before and after the study period. A total of 158 and 90 pregnant women with SCD were evaluated in the pre‐ and post‐ intervention periods, respectively. The maternal mortality rate decreased from 10 791 per 100 000 live births at pre‐intervention to 1176 per 100 000 at post‐intervention, representing a risk reduction of 89.1% (P = 0.007). Perinatal mortality decreased from 60.8 per 1000 total births at pre‐intervention to 23.0 per 1000 at post‐intervention, representing a risk reduction of 62.2% (P = 0.20). A multidisciplinary obstetric and hematology team approach can dramatically reduce maternal and perinatal mortality in a low‐resource setting.     

Risk factors for hospitalizations and readmissions among individuals with sickle cell disease: results of a U.S. survey study

Objective: Hospital admissions are significant events in the care of individuals with sickle cell disease (SCD) due to associated costs and potential for quality of life compromise.

Methods: This cross-sectional cohort study evaluated risk factors for admissions and readmissions between October 2014 and March 2016 in adults with SCD (n?=?201) and caregivers of children with SCD (n?=?330) at six centres across the U.S. Survey items assessed social determinants of health (e.g. educational attainment, difficulty paying bills), depressive symptoms, social support, health literacy, spirituality, missed clinic appointments, and outcomes hospital admissions and 30-day readmissions in the previous year.

Results: A majority of adults (64%) and almost half of children (reported by caregivers: 43%) were admitted, and fewer readmitted (adults: 28%; children: 9%). The most common reason for hospitalization was uncontrolled pain (admission: adults: 84%, children: 69%; readmissions: adults: 83%, children: 69%). Children were less likely to have admissions/readmissions than adults (Admissions: OR: 0.35, 95% CI: [0.23,0.52]); Readmissions: 0.23 [0.13,0.41]). For all participants, missing appointments were associated with admissions (1.66 [1.07, 2.58]) and readmissions (2.68 [1.28, 6.29]), as were depressive symptoms (admissions: 1.36 [1.16,1.59]; readmissions: 1.24 [1.04, 1.49]). In adults, difficulty paying bills was associated with more admissions, (3.11 [1.47,6.62]) readmissions (3.7 [1.76,7.79]), and higher spirituality was associated with fewer readmissions (0.39 [0.18,0.81]).

Discussion: Missing appointments was significantly associated with admissions and readmissions. Findings confirm that age, mental health, financial insecurity, spirituality, and clinic attendance are all modifiable factors that are associated with admissions and readmissions; addressing them could reduce hospitalizations.     

The course and correlates of high hospital utilization in sickle cell disease: Evidence from a large,urban Medicaid managed care organization

Although most patients with sickle cell disease (SCD) are hospitalized infrequently and manage painful crises at home, a small subpopulation is frequently admitted to emergency departments and inpatient units. This small group accounts for the majority of health care expenses for patients with SCD. Using inpatient claims data from a large, urban Medicaid MCO for 5 consecutive years, this study sought to describe the course of high inpatient utilization (averaging four or more admissions enrolled per year for at least 1 year) in members with a diagnosis of SCD and a history of hospitalizations for vaso‐occlusive crisis. High utilizers were compared with the other members with SCD on demographics, medical and psychiatric comorbidity, and use of other health care resources. Members who were high utilizers had more diagnostic mentions of sickle cell complications than low utilizers. However, the pattern of high inpatient utilization was likely to moderate over successive years, and return to the pattern after moderation was uncommon. Despite this, a small subpopulation engaged in exceptional levels of inpatient utilization over multiple years. Am. J. Hematol., 2009. © 2009 Wiley‐Liss, Inc.     

A randomized controlled trial comparing two vaso‐occlusive episode (VOE) protocols in sickle cell disease (SCD)

Limited evidence guides opioid dosing strategies for acute Sickle Cell (SCD) pain. We compared two National Heart, Lung and Blood (NHBLI) recommended opioid dosing strategies (weight‐based vs. patient‐specific) for ED treatment of acute vaso‐occlusive episodes (VOE). A prospective randomized controlled trial (RCT) was conducted in two ED's. Adults ≥ 21 years of age with SCD disease were eligible. Among the 155 eligible patients, 106 consented and 52 had eligible visits. Patients were pre‐enrolled in the outpatient setting and randomized to one of two opioid dosing strategies for a future ED visit. ED providers accessed protocols through the electronic medical record. Change in pain score (0‐100 mm VAS) from arrival to ED disposition, as well as side effects were assessed. 52 patients (median age was 27 years, 42% were female, and 89% black) had one or more ED visits for a VOE (total of 126 ED study visits, up to 5 visits/patient were included). Participants randomized to the patient‐specific protocol experienced a mean reduction in pain score that was 16.6 points greater than patients randomized to the weight‐based group (mean difference 95% CI = 11.3 to 21.9, P = 0.03). Naloxone was not required for either protocol and nausea and/or vomiting was observed less often in the patient‐specific protocol (25.8% vs 59.4%, P = 0.0001). The hospital admission rate for VOE was lower for patients in the patient‐specific protocol (40.3% vs 57.8% P = 0.05). NHLBI guideline‐based analgesia with patient‐specific opioid dosing resulted in greater improvements in the pain experience compared to a weight‐based strategy, without increased side effects.     

Impact on hospital admissions of an integrated primary care model for very frail elderly patients

Very frail elderly patients living in the community, present complex needs and have a higher rate of hospital admissions with emergency department (ED) visits. Here, we evaluated the impact on hospital admissions of the COPA model (CO-ordination Personnes Agées), which provides integrated primary care with intensive case management for community-dwelling, very frail elderly patients. We used a quasi-experimental study in an urban district of Paris with four hundred twenty-eight very frail patients (105 in the intervention group and 323 in the control group) with one-year follow-up. The primary outcome measures were the presence of any unplanned hospitalization (via the ED), any planned hospitalizations (direct admission, no ED visit) and any hospitalization overall. Secondary outcome measures included health parameters assessed with the RAI-HC (Resident Assessment Instrument-Home Care). Comparing the intervention group with the control group, the risk of having at least one unplanned hospital admission decreased at one year and the planned hospital admissions rate increased, without a significant change in total hospital admissions. Among patients in the intervention group, there was less risk of depression and dyspnea. The COPA model improves the quality of care provided to very frail elderly patients by reducing unplanned hospitalizations and improving some health parameters.     

A Geriatric Emergency Service for Acutely Ill Elderly Patients: Pattern of Use and Comparison with a Conventional Emergency Department in Italy

The current disease‐oriented, episodic model of emergency care does not adequately address the complex needs of older adults presenting to emergency departments (EDs). Dedicated ED facilities with a specific organization (e.g., geriatric EDs (GEDs)) have been advocated. One of the few GED experiences in the world is described and its outcomes compared with those of a conventional ED (CED). In a secondary analysis of a prospective observational cohort of 200 acutely ill elderly patients presenting to two urban EDs in Ancona, Italy, identifiers and triage, clinical, and social data were collected and the following outcomes considered: early (30‐day) and late (6‐month) ED revisit, frequent ED return, hospital admission, and functional decline. Death, functional decline, any ED revisit and any hospital admission were also considered as a composite outcome. Odds ratios and 95% confidence intervals (CIs) were calculated. Overall, GED patients were older and frailer than CED patients. The two EDs did not differ in terms of early, late, or frequent ED return or in 6‐month hospital admission or functional decline. The mortality rate was slightly but significantly lower in the GED patients (hazard ratio=0.47, 95% CI=0.22–0.99, P=.047). The data suggest noninferiority and, indirectly, a slight superiority for the GED system in the acute care of elderly people, supporting the hypothesis that ED facilities specially designed for older adults may provide better care.     

Secondhand smoke is associated with more frequent hospitalizations in children with sickle cell disease

Tobacco smoke exposure has been associated with more frequent hospitalizations in children with sickle cell disease (SCD), but previous studies have not quantified the exposure by objective methods. We enrolled 50 children and young adults with SCD in a retrospective and prospective cohort study and quantified tobacco smoke exposure by objective (salivary cotinine) and survey measures. We used a multivariable negative binomial regression model to evaluate the association between salivary cotinine and hospital admissions. Forty‐five percent (22/49) of participants had significant elevation of salivary cotinine (≥ 0.5 ng/ml). The incidence risk ratio (IRR) for hospital admission for those with elevated cotinine was 3.7 (95% CI 1.8–8). Those exposed to secondhand smoke but not primary smokers (cotinine between 0.5 and 10 ng/ml) had a similarly increased risk of hospitalization [IRR 4.3 (95% CI 1.8‐10)]. We show that an objective measure of tobacco smoke exposure, salivary cotinine, is strongly associated with the rate of hospital admissions in children and young adults with SCD. This association underscores the importance of screening for tobacco smoke exposure in people with SCD. Further investigation is warranted to determine the mechanisms of and to evaluate interventions to decrease tobacco smoke exposure. Am. J. Hematol. 91:313–317, 2016. © 2015 Wiley Periodicals, Inc.     

A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study

OBJECTIVES: To study the effects of comprehensive geriatric assessment (CGA) and multidisciplinary intervention on elderly patients sent home from the emergency department (ED). DESIGN: Prospective, randomized, controlled trial with 18 months of follow-up. SETTING: Large medical school-affiliated public hospital in an urban setting in Sydney, Australia. PARTICIPANTS: A total of 739 patients aged 75 and older discharged home from the ED were randomized into two groups. INTERVENTION: Patients randomized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital-based multidisciplinary outreach team. The team implemented or coordinated recommendations. The control group received usual care. MEASUREMENTS: The primary outcome measure was all admissions, to the hospital within 30 days of the initial ED visit. Secondary outcome measures were elective and emergency admissions, and nursing home admissions and mortality. Additional outcomes included physical function (Barthel Index (total possible score=20) and instrumental activities of daily living (/12) and cognitive function (mental status questionnaire (/10)). RESULTS: Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit (16.5% vs 22.2%; P=.048), a lower rate of emergency admissions during the 18-month follow-up (44.4% vs 54.3%; P=.007), and longer time to first emergency admission (382 vs 348 days; P=.011). There was no difference in admission to nursing homes or mortality. Patients randomized to the intervention group maintained a greater degree of physical and mental function (Barthel Index change from baseline at 6 months: -0.25 vs -0.75; P<.001; mental status questionnaire change from baseline at 12 months: -0.21 vs -0.64; P<.001). CONCLUSION: CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital. Patients aged 75 and older should be referred for CGA after an ED visit.     

Effect of an integrated care programme on re-hospitalization of patients with chronic obstructive pulmonary disease

Background and objective: Hospital admissions due to exacerbations of chronic obstructive pulmonary disease (COPD) have a major impact on disease progression and costs. We hypothesized that a 1‐year integrated care (IC) programme comprising two components (patient‐centred education + case management) would be effective in preventing COPD‐related hospitalizations. Methods: This was a retrospective longitudinal cohort study. Data were retrieved both from an administrative database in the province of Quebec (Canada), and from the medical records at two hospitals in Montreal. One hundred and eighty‐nine COPD patients were randomly selected from registers at these centres, from 2004 to 2006. Patients in the intervention group underwent a programme comprising two components: patient ‐centred education—involving three group sessions of self‐management education that included one motivational interview and instruction in the use of a written action plan; and case management—involving scheduled follow‐up visits with access to a call centre. The intervention group was compared with a group receiving usual care (UC). The main outcome was COPD‐related re‐hospitalizations, with length of hospital stay and emergency department (ED) visits being secondary outcomes. Results: Logistic regression analysis with adjustment for covariates showed that there was a lower probability of re‐hospitalization over the follow‐up year in the IC group compared with the UC group (odds ratio 0.44; 95% confidence interval 0.23–0.85). Subgroup analyses revealed that the IC programme prevented more COPD‐related hospitalizations in women compared with men. There were no significant between‐group differences in length of hospital stay or number of ED visits. Conclusions: An IC programme combining self‐management education and case‐management can decrease rates of COPD‐related hospitalizations, particularly among women.     

Differences in SLE disease activity between patients of Caucasian and South‐East Asian/Chinese background in an Australian hospital

Aim: We performed a semiprospective and retrospective review of all admissions to a single institution of systemic lupus erythematosus (SLE) patients, admitted due to active disease. The aim was to describe differences in disease activity as a cause of hospital admissions between patients originating from South‐East Asia/China (SAC) and Caucasians. Method: There were 210 patients admitted for active disease, with a total of 567 admissions for active SLE over a 16‐year period. Allowing for patients who had left our database, there was a total of 3415 patient years of observation. Results: Patients from SAC with a flare requiring admission presented earlier in their disease course and with more active disease than did Caucasians (median SLE Disease Activity Index 13 vs. 8, P= 0.002). They had longer inpatient stays (7 vs. 5 days P = 0.03). There was a trend to higher rates of re‐presentation to hospital for flare (59% in SAC patients vs. 41% in Caucasians, P = 0.09) with more subsequent admissions (3 vs. 2 P = 0.06) despite a shorter period of observation. Conclusions: South‐East Asian/Chinese were more likely to be diagnosed with class III/IV glomerulonephritis and require cyclophosphamide both at presentation and subsequent admissions. More patients from SAC were readmitted to hospital for severe central nervous system disease after their first hospital admission. In this population, lupus patients had more severe flares and more frequently required admission for these than Caucasians.     

Management of vaso-occlusive episodes in the day hospital decreases admissions in children with sickle cell disease

Acute vaso-occlusive episodes (VOE) are the most common reason for presentation to the Emergency Department (ED) and inpatient admission in people living with sickle cell disease (SCD). The goal of this study was to compare the hospital admission rate for VOE from our centre’s day hospital (Pediatric Ambulatory Chemotherapy and Transfusion Unit; PACT) versus the ED, and to determine which factors influence admission rate. The study included a total of 370 visits involving 140 children with SCD with a mean age of 10·9 ± 5·5 years. The timing from triage to the first analgesic was significantly different between the PACT and the ED (median, 32 vs. 70 min, P < 0·0001). The initial choice of opioid dosage adhered to our centre’s guidelines 84% of the time in the PACT v. 45% in the ED for morphine (P = 0·0003) and 100% in the PACT vs. 43% (P = 0·002) for hydromorphone. The admission rate from the ED (57%) was significantly higher than that of the PACT (29%) even when accounting for differences in baseline variables (P = 0·0001). In conclusion, the odds of being admitted were 3·8 times higher if the patient was treated in the ED. Timely administration and appropriate dosing of intravenous opioids may change this outcome in the future.     

Intensive care unit experience of haemopoietic stem cell transplant patients

Background: Previous research at our institution (1988–1998) established an intensive care unit (ICU) and hospital mortality between 70% and 80% in haemopoietic stem cell transplant (HSCT) patients requiring ICU admission. Aims: This study explored mortality in a more contemporary cohort while comparing outcomes to published literature and our previous experience. Methods: Retrospective chart review of HSCT patients admitted to ICU between December 1998 and June 2008. Results: Of 146 admissions, 53% were male, with a mean age of 44 years, an Acute Physiologic and Chronic Health Evaluation II score of 28 and Sepsis Organ Failure Assessment score of 11. Fifty‐six per cent had graft versus host disease (GVHD), with respiratory failure (67%) being the most common admission diagnosis. All but one received mechanical ventilation. The ICU and hospital mortality were 42% (72% 1988–1998 cohort) and 64% (82% 1998–1998 cohort) respectively. The 6‐ and 12‐month survivals were 29% and 24% respectively for the 1998–2008 cohort. Dying in ICU was independently predicted by fungal infection (P= 0.02) and early onset of organ failure (P < 0.001), while GVHD (P= 0.04) predicted survival. Mortality at 12 months was independently predicted by the acute physiology score (P= 0.002), increasing number of organ failures (P= 0.001), and cytomegalovirus positive serology (P= 0.005), while blood stream infection (P= 0.003), an antibiotic change on admission to the ICU (P= 0.007) and a diagnosis of non‐Hodgkin lymphoma (P= 0.02) predicted survival. Conclusion: Our study found that acute admission of HSCT patients to the ICU is associated with improved survival compared to our previous experience, with organ failure progression a strong predictor of ICU outcome, and specific disease characteristics contributing to long‐term survival.     

Readmission and survival following hospitalization for chronic obstructive pulmonary disease: long-term trends

Background: Exacerbations requiring hospital admission for chronic obstructive pulmonary disease (COPD) contribute to a decline in health status and are costly to the community. Long‐term trends in admissions and associated outcomes are difficult to establish because of frequent readmissions, high case fatality and potential diagnostic transfer between COPD and asthma. The Western Australian Data Linkage System provides a unique opportunity to examine admissions for patients with COPD over the long term. Method: Nineteen years of hospital morbidity data, based on International Classification of Diseases‐9 criteria were extracted from the Western Australian Data Linkage System (1980–1998) and merged with mortality records to examine trends in hospital admissions for COPD. Results: The rate of hospital admissions for COPD has declined overall and the rate of first presentation declined in men and remained constant in women. The risk of readmission increased throughout the period (P < 0.0001) and more than half of all admissions were followed by readmission within a year. Median survival following first admission was 6 years (men 5 years; women 8 years). Age, sex and International Classification of Diseases subcategory each showed an independent effect on the risk of mortality (P < 0.0001). The poorest survival was in patients subcategorized as emphysema. For patients with multiple admissions, the likelihood of cross‐over between COPD and asthma was high and increased with the total number of admissions. Conclusion: The rate of admission for COPD has declined in Western Australia; however, the resource burden will continue to increase because of the ageing population. This has policy implications for the development of acute care treatment programmes for COPD.     

Prospective evaluation of chronic organ damage in adult sickle cell patients: A seven‐year follow‐up study

Organ damage in sickle cell disease (SCD) is a crucial determinant for disease severity and prognosis. In a previous study, we analyzed the prevalence of SCD‐related organ damage and complications in adult sickle cell patients. We now describe a seven‐year follow‐up of this cohort.All patients from the primary analysis in 2006 (n = 104), were included for follow‐up. Patients were screened for SCD‐related organ damage and complications (microalbuminuria, renal failure, elevated tricuspid regurgitation flow velocity (TRV) (≥2.5 m/seconds), retinopathy, iron overload, cholelithiasis, avascular osteonecrosis, leg ulcers, acute chest syndrome (ACS), stroke, priapism and admissions for vaso‐occlusive crises (VOC) biannually. Upon 7 years of follow‐up, progression in the prevalence of avascular osteonecrosis (from 12.5% to 20.4%), renal failure (from 6.7% to 23.4%), retinopathy (from 39.7% to 53.8%) was observed in the whole group. In HbSS/HbSβ⁰‐thal patients also progression in microalbuminuria (from 34% to 45%) and elevated TRV (from 40% to 48%) was observed while hardly any progression in the prevalence of cholelithiasis, priapism, stroke or chronic ulcers was seen. The proportion of patients with at least one episode of ACS increased in the group of HbSS/HbSβ⁰‐thal patients from 32% to 49.1%. In conclusion, 62% of the sickle cell patients in this prospective cohort study developed a new SCD‐related complication in a comprehensive care setting within 7 years of follow‐up. Although the hospital admission rate for VOC remained stable, multiple forms of organ damage increased substantially. These observations underline the need for continued screening for organ damage in all adult patients with SCD.     

Pragmatic,Cluster Randomized Trial of a Policy to Introduce Low‐Low Beds to Hospital Wards for the Prevention of Falls and Fall Injuries

OBJECTIVES: To evaluate the efficacy of a policy to introduce low‐low beds for the prevention of falls and fall injuries on wards that had not previously accessed low‐low beds. DESIGN: This was a pragmatic, matched, cluster randomized trial with wards paired according to rate of falls. Intervention and control wards were observed for a 6‐month period after implementation of the low‐low beds on the intervention wards. Data from a 6‐month period before this were also collected and included in analyses to ensure comparability between intervention and control group wards. SETTING: Public hospitals located in Queensland, Australia. PARTICIPANTS: Patients of 18 public hospital wards. INTERVENTION: Provision of one low‐low bed for every 12 on a hospital ward, with written guidance for identifying patients at greatest risk of falls. MEASUREMENTS: Falls and fall injuries in the hospital measured using a computerized incident reporting system. RESULTS: There were 10,937 admissions to control and intervention wards combined during the pre‐intervention period. There was no significant difference in the rate of falls per 1,000 occupied bed days between intervention and control group wards after the introduction of the low‐low beds (generalized estimating equation coefficient=0.23, 95% confidence interval=?0.18–0.65, P=.28). The rate of bed falls, falls resulting in injury, and falls resulting in fracture also did not differ between groups. Some difficulties were encountered in intervention group wards in using the low‐low beds as directed. CONCLUSION: A policy for the introduction of low‐low beds did not appear to reduce falls or falls with injury, although larger studies would be required to determine their effect on fall‐related fractures.     

Hospital‐based intervention to enhance hypertension diagnosis in Kalasin hospital,Thailand, 2017‐2019: A pre‐post pilot intervention study

In Thailand 5.9 million individuals ≥15 years old have undiagnosed hypertension. The intervention to reduce undiagnosed hypertension was piloted and aimed to compare pre‐ and post‐intervention hypertension diagnosis rate and follow‐up rate. A hospital‐based pre‐ and post‐intervention study was piloted in a general hospital in Thailand. The intervention included an electronic pop‐up alert when raised blood pressure was observed and a follow‐up protocol. The follow‐up protocol entered patient information in a follow‐up book that scheduled an appointment to recheck blood pressure. Statistical analyses compared the rate of hypertension diagnosis and follow‐up between the pre‐ and post‐intervention periods, adjusted for differences in baseline characteristics. A post‐intervention, self‐report survey among nurses and nurse‐aids explored perceptions about raised blood pressure management and solicited suggestions to improve the intervention. 574 raised blood pressure patients visited the hospital in the pre‐intervention period; 27.4% returned for follow‐‐up; and hypertension diagnosis rate was 1.4%. Among 686 post‐intervention raised blood pressure patients, overall hypertension diagnosis rate improved to 6.1%. In per‐protocol patients, 81.9% were booked to follow‐‐up, hypertension diagnosis rate was 18.6%, and the adjusted odds ratio of hypertension diagnosis was 4.5 times higher compared with the pre‐intervention period. By self‐report, 20% of health workers had no time to provide the follow‐up book due to work overload, yet >57% reported that information technology improved detection of raised blood pressure and improved follow‐up. The interventions significantly increased the hypertension diagnosis rate and follow‐up among raised blood pressure patients in a single hospital but may benefit from incorporating an information technology‐assisted follow‐up protocol.     

Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome

Background: Despite the publication of several management guidelines for exacerbations of chronic obstructive pulmonary disease (COPD), there is little information on standards of care in clinical practice. The aim of this audit was to examine the assessment, management and outcome of COPD admissions to a secondary and tertiary referring New Zealand hospital during two different seasons. Compliance to current recommendations was examined and compared with the available international published work. Methods: All COPD‐related admissions to Waikato Hospital during the months of May and October 2004 were reviewed. Ninety‐four cases (from 84 patients) were audited. Results: General characteristics, clinical features and lung function tests were similar to that of other cohorts. Twenty‐three per cent of the admissions were Maori and the mean age of Maori admissions were significantly less than that of the non‐Maori admissions (57 and 72 years, respectively; P = 0.0001). The geometric mean length of stay was 3.4 days, which is significantly less than most other reported hospital lengths of stays related to exacerbations of COPD. Fifty‐five per cent of the cohort was admitted more than once to the hospital for COPD in the 12 months before the index admission. Thirteen per cent of all admissions received assisted ventilation. Overall 30‐day mortality was 8% and the 12‐month mortality was 31%. Decreased body mass index was a risk factor for death as was an increased CURB‐65 (confusion, urea, respiratory rate, blood pressure age) score – a simple bedside assessment score, which has previously been used to predict mortality in patients with community‐acquired pneumonia. Conclusion: This audit documented the general characteristics, assessment, management and outcome of the COPD admissions to a secondary New Zealand hospital. Further investigations into factors contributing to shorter length of stay and predictors of mortality are needed.