Development & Implementation of a Regional COPD Bundle

This project creates an opportunity to spread ‘homegrown’ research across our region, with an ambition to become a national programme if effective.


The NHS Long Term Plan identifies respiratory disease as a clinical priority; it affects one in five people and is the third biggest cause of death in England. Respiratory disease is also a priority for the ICS.

Hospital admissions for lung disease have risen over the past seven years at three times the rate of all admissions generally; they are a key driver of ‘winter pressures’.

The annual economic burden of COPD on the NHS in the UK is estimated at £1.9billion. In total, lung conditions directly cost the NHS in the UK £11billion annually.


The project

This is a quality improvement project to embed DECAF and PEARL into clinical practice around the region. This would be achieved by a respiratory consultant visiting all accident and emergency departments and medical admission units to provide education and support. Additionally, we will provide managers with evidence of the potential cost savings from the Hospital at Home study. Online education will be provided via the respiratory network.

The DECAF score is a prognostic risk score that can be used at the bedside to guide therapy in patients hospitalised with exacerbation of COPD. In several studies, including meta-analysis, it has been shown to accurately predict risk of death. In an NIHR-funded randomised controlled trial, DECAF was used to select low-risk patients for hospital at home treatment. This was preferential to patients, reduced the number of days a patient spends in a hospital bed and was less costly than usual in-hospital treatment. Of interest, the length of stay in DECAF 0-1 patients prior to the study was 5 days, and during the trial, the length of stay in usual care dropped to 3. This suggests that the use of the DECAF score encourages clinicians to send patients home sooner.

The PEARL score was developed to predict the risk of readmission or death at 90 days after discharge in patients hospitalised with exacerbation of COPD. The risk of readmission is high in the three months post-discharge. PEARL can help identify those patients at particularly high risk of readmission to guide services that aim to reduce readmission.


Delivery in the NENC

Professor Stephen Bourke, Northumbria Healthcare Trust, and Dr Carlos Echevarria, Newcastle upon Tyne Hospitals Trust are offering practical, clinical and educational support to all hospital trusts in our region to support embedding the use of DECAF and PEARL prognostic scores for all patients presenting with acute exacerbation of COPD.


DECAF and PEARL newsletter November 2021

For further information about the project please contact Sue Hart, Health Programme Manager [email protected]