RESPIRATORY INFECTIONS (F ARNOLD, SECTION EDITOR) Using Standardized Care Bundles in the Emergency Department to Decrease Mortality in Patients Presenting with Community- Acquired Pneumonia (CAP) and Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) Pedro J. Marcos & Arturo Huerta & Mark J. Enzler # Springer Science+Business Media New York 2015 Abstract There is significant variability when managing community-acquired pneumonia (CAP) and exacerbation of chronic obstructive pulmonary disease (COPD) in the emer- gency department among doctors, hospitals, and health sys- tems. This variability could contribute to the variable out- comes related with them. The use of standardized care bundles allows clinical teams to focus their efforts on a small number of measurable strategies aimed at improving specified out- comes. This article will review the importance of clinical care bundles when managing these diseases in the emergency de- partment and its potential to decrease mortality. Keywords Respiratory infections . Care bundle . COPD . CAP . Sepsis . Pneumonia . Acute exacerbation . Chronic bronchitis Introduction Acute respiratory tract infections are among the most common infections in patients who present to the emergency depart- ment (ED) patients [1]. Among all the respiratory infections, community-acquired pneumonia (CAP) and exacerbation of chronic obstructive pulmonary disease (COPD) are the two most relevant in terms of morbidity, mortality, hospital admis- sions, and cost [2–5]. Despite the availability of clinical guide- lines for managing both diseases [6–9], the reality is that there is significant variability of clinical practice when managing these patients within the health care systems [10•, 11]. The Importance of Care Bundles Appropriate disease management has been associated with improved outcomes in various diseases, including COPD. With the increasing complexity of management and pressure on clinicians’ time in delivering acute medical care, tools that help the physicians focus the most important evidence-based approaches to the patient care are crucial. One valuable tool is the use checklists or care bundles, where early studies have demonstrated their potential utility and capability in improv- ing patient safety [12]. Evidence-based care bundles in the ED are the core of the strategies to prevent mortality and improve outcomes in the setting of specific clinical presentations. Evidence-based care bundles have been defined as “a col- lection of processes needed to effectively and safely care for patients undergoing particular treatments with inherent risks. Several interventions are ‘bundled’ together and, when com- bined, significantly improve patient care outcomes” [13]. Care bundles should be clear, available to all clinicians, and evidence-based and should provide an easily available re- minder of elements of care vital to the improvement of clinical This article is part of the Topical Collection on Respiratory Infections P. J. Marcos (*) Servicio de Neumología. Instituto de investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC). As Xubias, 15006 A Coruña, Spain e-mail: pedro.jorge.marcos.rodriguez@sergas.es A. Huerta Emergency Department—Medicine and Respiratory Disease Section. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain e-mail: AHUERTA@clinic.ub.es M. J. Enzler Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA e-mail: enzler.mark@mayo.edu Curr Infect Dis Rep (2015) 17:2 DOI 10.1007/s11908-014-0458-1