A new, nurse-led ‘Respiratory Infections Team’ is delivering targeted and effective diagnosis and treatment for patients with community-acquired pneumonia leading to reduced hospital stays for the condition, according to a new study presented at the British Thoracic Society (BTS) Winter Meeting in December 2017.
Researchers revealed data showing that the new team has helped improve antibiotic stewardship and reduced the median length of stay by two days and for patients admitted to hospital with community-acquired pneumonia (CAP) by utilizing rapid S pneumoniae and Legionella Urinary Antigen Tests.
One year on, the full review of data from 301 patients is encouraging:
- Identification of the organism causing pneumonia increased from 4.9% the year prior, to 22.9%, leading to many more patients having targeted antibiotic strategies.
- Early supported discharge was appropriate for 30% of patients with low severity pneumonia, with no increase in hospital readmissions or mortality.
Despite evidence that targeted narrow spectrum antibiotics are safe, it is still routine practice to use broad spectrum antibiotics for patients with CAP, which leads to resistance to antibiotics and associated healthcare-associated infections.
In an attempt to tackle this and improve care, a new Respiratory Infections Team was established by respiratory consultant Dr Tom Bewick.
Consisting of one consultant, one specialist nurse and one antimicrobial pharmacist, the team focused on three core areas with all patients admitted to hospital with CAP:
- For those patients with low severity pneumonia, the team facilitated outpatient management with telephone support and follow up, providing many patients with the comfort of being at home, whilst reducing length of stay in hospital, and freeing up hospital beds.
- Performing point-of-care tests to identify as early as possible the infecting organism the patient is suffering from, enabling the provision of the correct targeted antibiotic, rather than providing broad spectrum antibiotics empirically, as previously carried out.
- Promoting adherence to the BTS CAP care bundle, such as patients receiving an X-ray within four hours and increasing diagnostic accuracy.
Dr Tom Bewick, Consultant Respiratory Physician at Derby Teaching Hospitals NHS Foundation Trust and member of the British Thoracic Society, said:
“This new team has helped deliver better care for patients by reducing the amount of time spent in hospital, reducing unnecessary antibiotic use and improving diagnostic accuracy”.
“This is a totally new service which improves care, is cost-effective and helps with the fight against antibiotic resistance. We hope other NHS trusts will pick it up and introduce similar versions. As we continue to face severe pressures on finding beds during winter, this is one way to free up NHS resources for those in most need.”
Derby Teaching Hospitals have also now received a grant from NHS England to expand this service, so the team now boasts three nurses for cover 365 days a year, offers follow-up clinics, and supports education and good practice across the Trust.