Impact of a community‐acquired pneumonia care bundle in North East England from 2014 to 2017—A quality improvement project
Abstract Objectives To explore the impact of implementation of Community‐Acquired Pneumonia (CAP) quality care bundle. Setting Eight acute hospitals in the North East of England and North Cumbria. Participants ICD‐10 coded CAP aged >18 were identified. A total of 16 201 CAP patients were discharg...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | The Clinical Respiratory Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/crj.13271 |
| _version_ | 1798019993749684224 |
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| author | Gerry Morrow Anthony Roberts Julia Newton Jon Rees Michael Walkley Linda Flavell |
| author_facet | Gerry Morrow Anthony Roberts Julia Newton Jon Rees Michael Walkley Linda Flavell |
| author_sort | Gerry Morrow |
| collection | DOAJ |
| description | Abstract Objectives To explore the impact of implementation of Community‐Acquired Pneumonia (CAP) quality care bundle. Setting Eight acute hospitals in the North East of England and North Cumbria. Participants ICD‐10 coded CAP aged >18 were identified. A total of 16 201 CAP patients were discharged 2016/2017 (15 707; 2015/2016 and 10 733; 2014/2015). Outcome measures Secondary User Service (SUS) data were collected monthly from April 2014 to 2017. Data were pseudonymised and data flows governed by Data Sharing Agreements. CAP measures were based on British Thoracic Society guidance and agreed following clinician consultation. CAP admissions and individual organisational compliance with and impact of, CAP quality bundle measures was explored. Results Average length of stay (LOS) was 10.4 days (median 6) 25% >13 days. Crude in‐hospital mortality rate was 17.6%, significantly lower (95% CI) than 19.1% in 2015/2016 and 19.3% in 2014/2015. Emergency readmissions within 28 days were 19.7% (19.2%; 2015/2016, 17.9%; 2014/2015). A total of 39.5% of patients received all appropriate care measures. Compliance has improved over time, although not for all hospitals. Most quality measures have higher mortality for those passing measures compared to those failing (P < .05 95% CI). Giving oxygen, had a significantly higher emergency readmission rate, 3.3% higher (95% CI 1.1% to 5.5%). Appropriate antibiotics and recording CURB‐65 scores reduced the emergency readmission rates (−2.7% (95% CI −4.5% to −0.8%) −2.6% (95% CI −3.8% to −1.4%), respectively, (P = ns)). Conclusion CAP accounts for significant bed days, mortality and readmissions. Although mortality was lower, LOS and readmission rates were not, despite improvements in compliance after implementation of the care bundle. Care bundle use remained sub‐optimal. |
| first_indexed | 2024-04-11T16:49:34Z |
| format | Article |
| id | doaj.art-13ebdfac98b24b38892e28bad9ab1341 |
| institution | Directory Open Access Journal |
| issn | 1752-6981 1752-699X |
| language | English |
| last_indexed | 2024-04-11T16:49:34Z |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Clinical Respiratory Journal |
| spelling | doaj.art-13ebdfac98b24b38892e28bad9ab13412022-12-22T04:13:28ZengWileyThe Clinical Respiratory Journal1752-69811752-699X2021-01-01151748310.1111/crj.13271Impact of a community‐acquired pneumonia care bundle in North East England from 2014 to 2017—A quality improvement projectGerry Morrow0Anthony Roberts1Julia Newton2Jon Rees3Michael Walkley4Linda Flavell5North East Quality Observatory Service Newcastle upon Tyne UKSouth Tees Hospitals NHS Foundation Hospital The James Cook University Hospital Middlesbrough UKAcademic Health Science Network North East and North Cumbria Newcastle upon Tyne UKSchool of Psychology Faculty of Health Sciences and Wellbeing University of Sunderland Sunderland UKSouth Tees Hospitals NHS Foundation Hospital The James Cook University Hospital Middlesbrough UKClarity Informatics Limited Newcastle upon Tyne UKAbstract Objectives To explore the impact of implementation of Community‐Acquired Pneumonia (CAP) quality care bundle. Setting Eight acute hospitals in the North East of England and North Cumbria. Participants ICD‐10 coded CAP aged >18 were identified. A total of 16 201 CAP patients were discharged 2016/2017 (15 707; 2015/2016 and 10 733; 2014/2015). Outcome measures Secondary User Service (SUS) data were collected monthly from April 2014 to 2017. Data were pseudonymised and data flows governed by Data Sharing Agreements. CAP measures were based on British Thoracic Society guidance and agreed following clinician consultation. CAP admissions and individual organisational compliance with and impact of, CAP quality bundle measures was explored. Results Average length of stay (LOS) was 10.4 days (median 6) 25% >13 days. Crude in‐hospital mortality rate was 17.6%, significantly lower (95% CI) than 19.1% in 2015/2016 and 19.3% in 2014/2015. Emergency readmissions within 28 days were 19.7% (19.2%; 2015/2016, 17.9%; 2014/2015). A total of 39.5% of patients received all appropriate care measures. Compliance has improved over time, although not for all hospitals. Most quality measures have higher mortality for those passing measures compared to those failing (P < .05 95% CI). Giving oxygen, had a significantly higher emergency readmission rate, 3.3% higher (95% CI 1.1% to 5.5%). Appropriate antibiotics and recording CURB‐65 scores reduced the emergency readmission rates (−2.7% (95% CI −4.5% to −0.8%) −2.6% (95% CI −3.8% to −1.4%), respectively, (P = ns)). Conclusion CAP accounts for significant bed days, mortality and readmissions. Although mortality was lower, LOS and readmission rates were not, despite improvements in compliance after implementation of the care bundle. Care bundle use remained sub‐optimal.https://doi.org/10.1111/crj.13271community‐acquired pneumoniaICD‐10 codestandardised hospital mortality |
| spellingShingle | Gerry Morrow Anthony Roberts Julia Newton Jon Rees Michael Walkley Linda Flavell Impact of a community‐acquired pneumonia care bundle in North East England from 2014 to 2017—A quality improvement project The Clinical Respiratory Journal community‐acquired pneumonia ICD‐10 code standardised hospital mortality |
| title | Impact of a community‐acquired pneumonia care bundle in North East England from 2014 to 2017—A quality improvement project |
| title_full | Impact of a community‐acquired pneumonia care bundle in North East England from 2014 to 2017—A quality improvement project |
| title_fullStr | Impact of a community‐acquired pneumonia care bundle in North East England from 2014 to 2017—A quality improvement project |
| title_full_unstemmed | Impact of a community‐acquired pneumonia care bundle in North East England from 2014 to 2017—A quality improvement project |
| title_short | Impact of a community‐acquired pneumonia care bundle in North East England from 2014 to 2017—A quality improvement project |
| title_sort | impact of a community acquired pneumonia care bundle in north east england from 2014 to 2017 a quality improvement project |
| topic | community‐acquired pneumonia ICD‐10 code standardised hospital mortality |
| url | https://doi.org/10.1111/crj.13271 |
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