Box 2.

Improving use of the chronic obstructive pulmonary disease hospital discharge bundle

Chronic obstructive pulmonary disease (COPD) accounts for around 10% of emergency hospital medical admissions in the UK, totalling 90,000 patients a year.21 Around one-quarter of these patients are re-admitted to hospital within 30 days, rising to 43% within 90 days.22 To support improvements in the care of COPD patients admitted to hospital with an acute exacerbation, and to reduce the risk of readmission to hospital, the British Thoracic Society (BTS) developed and piloted a hospital discharge care bundle.23 The BTS Bundle consists of the following components, which research found to be associated with a reduction in the 30-day readmission rate:24

  • review patient's medication and demonstrate use of inhalers

  • provide written self-management plan and emergency drug pack

  • assess and offer referral for smoking cessation

  • assess for suitability for pulmonary rehabilitation

  • appropriate follow-up call within 72 hours of discharge.


In 2019, each regional PSC began working with its local hospital to support the effective and consistent implementation of the bundle. Hospitals have been provided with a wide range of support including access to networks to share best practice, provision of data dashboards to show progress with uptake of the bundle, and coaching in quality improvement skills to enable teams to initiate local improvement work. Regional PSCs have also supported hospitals to improve the accuracy of the data reported through the National Asthma and COPD Audit Programme (NACAP). This work is ongoing, and acute and non-respiratory physicians, particularly care of the elderly physicians, are especially encouraged to participate given the challenge of ensuring uptake of the bundle for patients under their care.