Earlier and better support are improving the lives of patients with respiratory conditions, finds Matthew Limb
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.”
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 …

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2020年BMJ奖：年度呼吸器团队

Matthew Limb
社区发现，获得性肺炎是医院入院的主要原因，早期和更好的支持正在改善呼吸道疾病患者的生活。但是，护理质量和患者预后往往很差，抗生素处方过多，大多数低危患者仍留在医院。
一个呼吸道感染小组，由三名专职护士提供顾问和药剂师的支持，旨在增进与美国国家卫生与护理卓越学院准则的一致性；确定低严重度社区获得性肺炎的患者以进行门诊治疗，并实施早期电话支持的出院和随访；并在入院后48小时内通过即时护理微生物学测试简化抗生素治疗，从而减少了处方抗生素的总量。
该小组审查了1336例确诊为社区获得性肺炎的患者，并将结果与​​干预前队列进行了比较。与调整肺炎严重程度后进行干预前相比，住院时间缩短了（低严重度3.4 v4.5天，中度5.4 v 7.7天，高度6.5 v 8.7天），再入院率未改变。
较低严重度组的死亡率无变化（2.7％vs 2.6％），但较高严重度组的干预后死亡率较低（13.1％v 30.1％）。
微生物学诊断率几乎增加了两倍，处方的广谱抗生素的使用量有所减少。
“我们的团队通过缩短住院时间并在社区康复期间为患者提供帮助，”呼吸科医师汤姆·贝威克（Tom Bewick）表示。“它通过使用新颖的即时护理床边微生物测试，促进对指南的遵守和简化抗生素治疗方案，从而促进了高质量的护理。”
由于呼吸咨询师职位空缺和全科医生转诊人数增加，患者等待了很长一段时间才能接受阻塞性睡眠呼吸暂停的检查。
阻塞性睡眠呼吸暂停的患者白天会嗜睡，打呼and和呼吸中断很大……