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Respiratory infection
Specialist pneumonia intervention nurse service improves pneumonia care and outcome
  1. Robert C Free1,
  2. Matthew Richardson1,
  3. Camilla Pillay2,
  4. Kayleigh Hawkes3,
  5. Julie Skeemer3,
  6. Rebecca Broughton4,
  7. Pranabashis Haldar1 and
  8. Gerrit Woltmann1,3
  1. 1Department of Respiratory Sciences, University of Leicester, Leicester, UK
  2. 2Renal Unit, King's College Hospital, London, UK
  3. 3Respiratory Medicine Department, Glenfield Hospital, Leicester, UK
  4. 4Corporate Medical and Nursing, University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to Dr Gerrit Woltmann; gerrit.woltmann{at}uhl-tr.nhs.uk

Abstract

Background A specialist pneumonia intervention nursing (SPIN) service was set up across a single National Health Service Trust in an effort to improve clinical outcomes. A quality improvement evaluation was performed to assess the outcomes associated with implementing the service before (2011–2013) and after (2014–2016) service implementation.

Results The SPIN service reviewed 38% of community-acquired pneumonia (CAP) admissions in 2014–2016. 82% of these admissions received antibiotic treatment in <4 hours (68.5% in the national audit). Compared with the pre-SPIN period, there was a significant reduction in both 30-day (OR=0.77 (0.70–0.85), p<0.0001) and in-hospital (OR=0.66 (0.60–0.73), p<0.0001) mortality after service implementation, with a review by the service showing the largest independent 30-day mortality benefit (HR=0.60 (0.53–0.67), p<0.0001). There was no change in length of stay (median 6 days).

Conclusion Implementation of a SPIN service improved adherence to BTS guidelines and achieved significant reductions in CAP-associated mortality. This enhanced model of care is low cost, highly effective and readily adoptable in secondary care.

  • pneumonia
  • respiratory infection

Data availability statement

No data are available. This manuscript was the result of a service improvement exercise. Consequently, we do not have ethical approval to share the data used to produce the conclusions in this paper.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/bmjresp-2020-000863

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    Data availability statement

    No data are available. This manuscript was the result of a service improvement exercise. Consequently, we do not have ethical approval to share the data used to produce the conclusions in this paper.

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    Footnotes

    • Contributors RF implemented the data collection tools, carried out the data extraction and analysis, and wrote the manuscript. MR provided statistical advice, data analysis and manuscript review. CP collected data. JS led the SPIN team and collected data. KH contributed to SPIN and collected data. RB contributed to data analysis and Trust-wide implementation. PH wrote the manuscript and provided critical review. GW conceived the SPIN approach, wrote the manuscript and is the guarantor.

    • Funding This research was co-funded by the NIHR Leicester Biomedical Research Centre and the NHS Commissioning for Quality and Innovation framework.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.