- Page navigation anchor for RE: response to Dr EbyRE: response to Dr Eby
We thank Dr Eby for his interest in our article. The first author has 37 years experience working in a large ED and is very familiar with the complexities of making admission decisions. In our paper we go to great lengths to indicate that medical risk of a poor outcome is only one factor to consider, along with many others: "Many nonmedical factors are important in the decision to admit a patient, such as support at home or availability of early followup. We see OCRS as an important tool to help physicians gauge
the medical risk for their patients with COPD, while they determine the need for admission or early follow-up."
Best regards
Ian StiellCompeting Interests: None declared. - Page navigation anchor for RE: Guidelines, scores, and 'unnecessary admissions'RE: Guidelines, scores, and 'unnecessary admissions'
Speculation that using the Ottawa chronic obstructive pulmonary disease (COPD) Risk Scale (OCRS) “should lead to a decrease in unnecessary admissions and unsafe discharges”(1) is interesting. However, the OCRS omits the most important risk factor clinicians should consider when deciding whether or not to admit a person with a COPD exacerbation - the social support and help the person has at home. The most significant question is: will this patient be able to manage their condition in that setting? Scores never seem to include this item.
The OCRS and the accompanying editorial emphasise that co-morbidities are a large determinant of serious outcomes of exacerbations of COPD. (1,2) We are well advised to consider both a person’s multiple morbidities and social situation in admission decisions.
The authors of the clinical validation of the OCRS speculate that the use of the score should lead to a decrease in unnecessary admission while the editorial notes the use of the ORCS might actually increase the rate of admissions! (1,2) This assumes that clinicians follow guidelines and scores literally. They don’t. (3,4)
One further point. As someone who has spent a long time working at ‘the coal face’ in the Emergency Department of a busy hospital, I struggle with and feel great pressure to avoid ‘unnecessary’ admissions every shift I work. ‘Unnecessary admission’ is a pejorative label, frequently used in metrics and dashboards by health planners and administra...
Show MoreCompeting Interests: None declared.
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