The BMJ Awards 2020: Respiratory team of the year

Better support for pneumonia patients shortened hospital stays and reduced antibiotic use

Community acquired pneumonia is a major cause of hospital admission. But care quality and patient outcomes are often poor, with overprescribing of antibiotics and most low severity patients remaining in hospital.

A respiratory infections team, comprising three specialist nurses with consultant and pharmacist support, aimed to improve concordance with National Institute for Health and Care Excellence guidelines; identify patients with low severity community acquired pneumonia for outpatient management, implementing early telephone supported discharge and follow-up; and facilitate streamlining of antibiotic treatment using point-of-care microbiological tests within 48 hours of admission, reducing the total amount of antibiotics prescribed.

The team reviewed 1336 patients with confirmed community acquired pneumonia and compared outcomes with a pre-intervention cohort. Length of stay was reduced when compared with pre-intervention after adjustment for pneumonia severity (low severity 3.4 v 4.5 days, moderate severity 5.4 v 7.7 days, high severity 6.5 v 8.7 days), and readmission rate was unchanged.

Mortality was unchanged in lower severity groups (2.7% v 2.6%), but there was lower mortality in the high severity group post-intervention (13.1% v 30.1%).

The rate of microbiological diagnosis almost tripled, and there was a reduction in the amount of broad spectrum antibiotics prescribed.

“Our team helps patients by reducing their length of hospital stay and supporting them during their recovery in the community,” says consultant respiratory physician Tom Bewick. “It facilitates high quality care by promoting adherence to guidelines and streamlining of antibiotic regimens using novel point-of-care bedside microbiological tests.”

Redirection of patients with sleep problems radically reduced waiting times

Patients were waiting a long time to be investigated for obstructive sleep apnoea as a result of unfilled respiratory consultant posts and rising GP referrals.

Patients with obstructive sleep apnoea experience daytime sleepiness, and loud snoring and breathing interruptions …