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

Abstract 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.