Bedford Hospital Integrated Chronic Obstructive Pulmonary Disease (ICOPD)


The Bedfordshire Integrated COPD (ICOPD)

This is an innovative and ground-breaking service with two general hospitals working together to provide one 'unified' equitable service for the patients of Bedfordshire. The service is provided by The Luton and Dunstable Hospital NHS Foundation Trust and Bedford Hospital NHS Trust, on behalf of NHS Bedfordshire.

The ICOPD Team includes respiratory consultants/physician, respiratory nurse specialists, specialist respiratory physiotherapists and occupational therapist. The following services are provided for patients who have a confirmed diagnosis of COPD:

  • Acute Respiratory Assessment Service (ARAS)
  • Early Supported Discharge (ESD)
  • Respiratory Nurse Intervention Community Clinics
  • Respiratory Physician Community Clinics
  • Pulmonary Rehabilitation Programme
  • Home Oxygen Service

The key components of the ICOPD service are:

  • Acute Respiratory Assessment Service (ARAS): dedicated mobile phone: 01234 730343
  • Review of exacerbating COPD patients who are not responding to treatment
    8.30am - 4.00pm Monday - Friday

Early Support Discharge Scheme (ESD)

Patients who are admitted to hospital and are identified as suitable for discharge home with support from the ICOPD team. They remain under the care of the hospital until fit for full discharge.

ICOPD team will work as a multi-disciplinary team and refer to relevant agencies to enable safe discharge and help prevent re-admission.

Intervention Clinics

  • Run by respiratory nurse specialist and supported by chest physicians.
  • Following referral, the ICOPD team will ensure patients are seen in the most appropriate setting (community or secondary care).

Pulmonary Rehabilitation

  • Suitable for patients with an MRC ≥3
  • Three venues are available:
  • Julilation Centre: Jubilee Park, Moulton Ave, Bedford, MK42 0HL
  • Sandy Village Hall: Medusa Way, Sandy, Bedfordshire, SG19 1BN
  • Flitwick Village Hall: Dunstable Rd, Flitwick, Bedfordshire, MK45 1HP
  • Patients attend sessions twice a week, for seven weeks
  • Run by specialist physiotherapist, respiratory nurse specialists and Occupational Therapist.
  • Domiciliary Pulmonary Rehabilitation available.
  • Respiratory Exercise Group available.

Respiratory Physician & Respiratory Nurse Specialist Intervention clinics are held as follows:

  • Priory Medical Centre: 1st Tuesday in the month: 2pm-5.30pm
  • Shefford Health Centre: 2nd Wednesday in the month: 2pm-5.30pm
  • The Highlands, Flitwick: 3rd Tuesday in the month: 2pm-5.30pm
  • Wooton Vale Healthy Living Centre: 4th Tuesday in the month: 2pm-5.30pm

Home Oxygen Service (HOS)

Monday - Friday 8am - 5pm

Referrals accepted from G/P's/ Practice Nurses/ Community Matrons/ Palliative Care team specialists/Respiratory specialists.

Referrals accepted via HOS referral form/Integrated ICOPD form: fax/post. Telephone referrals accepted: 01234 795859      Fax: 01234 792077

Who to Refer

Patients with a Sp02 <92% on room air at rest or <90% on exertion.

Patients with a confirmed diagnosis of COPD + on optimum inhaler therapy.

Patients with other confirmed respiratory diagnosis suffering from chronic hypoxaemia e.g. Interstitial lung fibrosis, bronchiectasis and chronic asthmatics.

All patients referred should be clinically stable for a minimum period of 4 weeks prior to assessment.

Assessment Venues:

Following referral the HOS team will ensure the patients are seen in the most appropriate setting (community/secondary care).

Follow up/review

The frequency of review will be dependent upon the type of oxygen therapy prescribed for the patient i.e.

Long Term Oxygen Therapy: Minimum of 6 monthly reviews alternating between home visits and secondary/community clinic.

Ambulatory Oxygen Therapy: Minimum of 6 monthly reviews alternating between home visits and secondary/community clinics. 

Short Burst Oxygen Therapy: Annual review either in the home or secondary/community clinic.

Intervention Clinics

  • Suitable for specialist assessment, management advice and interventions

Diagnostic uncertainty

  • Suspected severe COPD
  • Patient requests second opinion
  • Assessment /review of oxygen therapy
  • Assessment for nebuliser therapy
  • Assessment of oral corticosteroid therapy
  • Symptoms out of proportion to spirometry

Pulmonary Rehabilitation

  • Suitable for patients with an MRC ≥3
  • People who have had two or more hospital admissions in the last six months
  • People who have had two or more exacerbations in the last six months
  • People who  have an inability to cope with (two or more of the following):
    • Panic attacks
    • Reduced confidence
    • Increased anxiety
    • MRC dyspnoea >2

Who not to Refer

Patients with the following symptoms should be referred to the Department of Respiratory Medicine at Bedford Hospital:

  • Onset of Cor Pulmonale (Ankle oedema, left parasternal heave, Tricuspid regurgitation)
  • Assessment for initiating oxygen therapy ( this is initiating not review so not repeated)
  • Bullous lung disease
  • Assessment for lung transplant/lung volume reduction
  • Age under 35, or family history of alpha1-antitrypsin deficiency
  • Frequent infection or haemoptysis
  • Suspected respiratory failure - symptoms such as profound shortness of breath, inability to complete sentences, peripheral or central cyanosis, increasing drowsiness, confusion, worsening peripheral oedema.
  • Any patients with documented acute asthma*
  • Patients with suggestions of lung conditions other than COPD*
  • Patients with TB*
  • Patients with interstitial lung disease*

*Note: These patients will require respiratory physician review

For Pulmonary Rehabilitation do not refer patients with:

  • Symptomatic cardiac failure
  • Hypertension (systolic > 240mg, diastolic>120mg)
  • Uncontrolled/brittle asthma
  • Myocardial Infarction within six weeks
  • Severe/uncontrolled epilepsy
  • Unstable angina
  • Tachycardia (>120bpm at rest)

Last updated: 11/12/2014

Update due: 11/12/2015