The feasibility, efficacy and safety of a multidisciplinary care pathway for in-patient treatment of acute exacerbation of bronchiectasis

Patients admitted with acute exacerbations of bronchiectasis are a distinct population who has a significant morbidity and mortality. There are no known evidence based clinical pathways for the inpatient management of these patients. Aim: To evaluate the feasibility, safety and efficacy of an evidence based clinical pathway designed for in-hospital management of patients with acute exacerbations of bronchiectasis. Method: A retrospective analysis on all adult patients admitted with acute exacerbations of bronchiectasis between November 2013 and April 2014. Age, sex, length of hospital stay and co-morbidities were established. Patients were divided into 2 groups: 1) care pathway group (CP) and (2) non care pathway group (non-CP). The efficacy is defined as the event rate of recurrent hospitalization with acute bronchiectasis exacerbation within 30 days post discharge. The safety outcome is defined as the rate of mortality within 30 days post discharge. Results: A total of 125 patients were identified. 34 patients were in CP and 91 patients in non-CP group. There were no significant differences in age, gender and co-morbidities between the 2 groups. The median (IQR) length of hospital stay was significantly lower in the CP than the non-CP (4(3-6) vs 6(3-10) days; p=0.023). The readmission rate was 9% in the CP and 20% in non-CP (p=NS). The mortality was similar in both groups (9% vs 10%, p=NS). Conclusion: Our data suggests that managing patients with acute exacerbations of bronchiectasis using a clinical pathway specifically designed for this group of patients is feasible, safe and efficacious with the potential of reducing hospital length of stay.