The impact of an emergency department‐based advanced care unit on medical admissions, inter‐hospital transfers, and clinical outcomes for severe acute exacerbation of chronic obstructive pulmonary disease: A retrospective cohort study at North Lantau
Hui Pong Lai, Man Ting Lau, Oi Fung Wong, Shing Ko, Yu Tai Chan, Lo Wa Amy Ng, Tin Man Hui, Ka In Chan, Sau Lai Chan, Lai Fan Yip, Wai Kai ChanAbstract
Background
North Lantau Hospital (NLTH) is a community hospital. The Emergency Medicine Advanced Care Unit (EMACU) was established to provide local critical care to unstable patients.
Objective
To evaluate the impact of EMACU on medical admissions and to compare outcomes between severe acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients managed in EMACU and a historical control.
Methods
A retrospective pre‐post study compared two periods: pre‐EMACU (2018–2019) and post‐EMACU (2023–2024). The primary outcome was the proportion of AECOPD patients admitted to Princess Margaret Hospital (PMH). Secondly, severe AECOPD patients directly admitted to EMACU for non‐invasive ventilation (NIV) support ( n = 12) and a historical control of patients from the pre‐EMACU era who were transferred with NIV support or required immediate NIV at PMH ( n = 8), were compared.
Results
Medical admissions to PMH fell from 34.6% (164/474) to 11.6% (57/490) after EMACU establishment ( p < 0.001). In the post EMACU period, no patient was transferred in unstable condition and required immediate NIV at PMH. In the comparison of severe patients, there was no significant difference in median total hospital LOS among survivors (EMACU: 12.5 days, range 4–28 vs. Control: 13.5 days, range 10–28, p = 0.98). The hospital mortality was 16.7% (2/12) in the EMACU cohort versus 0% (0/8) in the control ( p = 0.49). All post‐EMACU transfers ( n = 4) were stable and planned.
Conclusion
EMACU significantly reduced medical admissions and eliminated transfers for unstable AECOPD patients, with comparable clinical outcomes to historical control. This mode of localized, intensivist‐led care is safe and effective in community hospital setting.