Timeliness and Documented Guideline Concordance of Initial Management for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Background: Early management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) requires coordinated assessment, prompt symptom-directed treatment, recognition of respiratory failure and timely escalation. Reliability across these processes was unknown at University Hospital Kerry.

Objective: To measure the documented timeliness and delivery of predefined assessment, treatment, safety and specialist-care processes for adults presenting to the emergency department with AECOPD.

Methods: We conducted a baseline, single-centre descriptive clinical audit of 30 adult emergency presentations between 20 July and 20 August 2026. Fifteen process criteria were abstracted from clinical records into a structured audit form. Compliance was calculated as the number of “Yes” responses divided by the total number of “Yes” and “No” responses; records classified as not applicable were excluded from the criterion-specific denominator. Results are reported as counts, percentages and Wilson 95% confidence intervals.

Results: Two of 15 criteria achieved at least 80% documented compliance: admission blood testing (27/30, 90.0%; 95% CI 74.4%–96.5%) and review of laboratory results within two hours (24/30, 80.0%; 95% CI 62.7%–90.5%). Controlled oxygen was documented in 9/12 applicable presentations (75.0%), systemic corticosteroid within four hours in 18/30 (60.0%), and an antibiotic within four hours in 15/27 applicable presentations (55.6%). Lower rates were observed for nebulised bronchodilator within 30 minutes (6/30, 20.0%), initial arterial blood gas within 30 minutes (9/30, 30.0%), repeat blood gas following oxygen or non-invasive ventilation change (6/18, 33.3%), appropriate venous thromboembolism prophylaxis within eight hours (3/30, 10.0%), respiratory review within 24 hours (12/30, 40.0%) and COPD outreach assessment within four hours (0/30).

Conclusions: Documented routine investigation processes were more reliable than time-critical treatment, reassessment, prevention and specialist escalation. Because eligibility and reasons for non-delivery were incompletely differentiated, these findings identify process and documentation gaps rather than proving inappropriate care in individual cases. A locally approved, timestamped AECOPD admission bundle with explicit exception coding and prospective re-audit is warranted.