A Proposed Checklist for Optimizing COPD Patient Discharge Processes in Italian Internal Medicine Wards

Alberto Benetti,1 Elisa Maria Fiorelli,2 Davide Grassi,3 Nicola Montano2,4 1Internal Medicine Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 2Internal Medicine, Immunology and Allergology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 3Internal Medicine and Nephrology Unit, San Salvatore Hospital, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy; 4Department of Clinical Sciences and Community Health, University of Milan, Milan, ItalyCorrespondence: Elisa Maria Fiorelli, Internal Medicine, Immunology and Allergology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy, Email [email protected]: Chronic obstructive pulmonary disease (COPD) is a major cause of hospital admissions and readmissions, particularly following acute exacerbations. The immediate post-discharge period is a vulnerable phase, often marked by clinical instability, poor adherence, and unaddressed needs related to inhaler use, comorbidities and rehabilitation. Despite guideline recommendations, key evidence-based interventions are often overlooked in hospital discharge processes, particularly in internal medicine wards where COPD may not be the primary focus. We conducted a targeted literature search using Medline/PubMed, screening approximately 240 relevant articles that support interventions across key domains of COPD discharge care. Building on this evidence, this narrative review and expert opinion aims to raise awareness and prompt systematic implementation of essential post-discharge care components and propose a structured COPD discharge checklist aimed at standardizing care and improving post-discharge outcomes. These include initiation of smoking cessation support, optimization of maintenance therapy, assessment and correction of inhaler technique, evaluation of vaccination status, referral to pulmonary rehabilitation, scheduling of early follow-up visits, and structured patient education on self-management strategies. The checklist is grounded in current evidence demonstrating that comprehensive discharge bundles reduce 30-day readmissions, enhance quality of life, and prevent further clinical deterioration. Early pulmonary rehabilitation, particularly within 3 weeks post-discharge, and timely initiation of appropriate pharmacotherapy, including triple inhaled therapy when indicated, further reduce exacerbation risk and healthcare utilization. By integrating these elements into a concise and actionable format, the checklist aims to support internists in delivering high-quality, standardized COPD care during hospital discharge. Broad adoption may improve care transitions, promote adherence to best practices, and ultimately enhance outcomes for patients with COPD.Keywords: chronic obstructive pulmonary disease, hospital readmission, treatment optimization, patient discharge, discharge checklist