It is important to do an assessment of your practice to evaluate where your practice stands. This is a part of the quality improvement process that should be undertaken by each hospital that seeks to achieve excellence in care delivery by meeting or exceeding guidelines.

• We have seen that usually the main focus is on acute care, but each emergency visit and/or hospitalization must be treated as an opportunity to optimize chronic disease management, where the main focus is to prevent and reduce complications related to COPD and exacerbation.

Assess how your practice qualifies, as compared to the best practice guidelines. Since evidence-based guidelines are constantly changing as a result of new studies, it is a challenge to make sure that this new knowledge gets translated into day-to-day practices. Therefore assessment is part of a continuous process of quality improvement.

• Specifically considering COPD, we recommend looking at the recommendations made by the Canadian Thoracic Society ¹ which can be seen on their Web site.

[1] DE O'Donnell, S Aaron, J Bourbeau, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2007 update. Can Respir J 2007;14(Suppl B):5B-32B

Do not assume that the best practices are in place in your institution, or that you know all about them; you need to do a formal assessment "Gaps in care".