Community acquired pneumonia (CAP) is the leading cause of deaths in NHS hospitals. The creation of a new specialist pneumonia intervention nurse (SPIN) service has helped to significantly reduce the number of patients dying from pneumonia in hospital, according to new research from Leicester’s Hospitals, presented at the British Thoracic Society Winter Meeting today (Wednesday 5th December 2018).
Based on their 5 year study, results of lung specialists from Leicester’s Hospitals conclude that if a highly focussed pneumonia intervention nursing service were rolled out across the NHS it could save thousands of lives every year. Such a service also supports medical emergency admission teams during the winter pressure period.
At a national level pneumonia and flu caused 269,313 emergency hospital admissions in the UK in 2016/17 which cost the NHS an estimated £1 billion.
Prompt interventions to save lives
To tackle the problem Dr Gerrit Woltmann, consultant respiratory physician at Leicester’s Hospitals and informatics lead at the NIHR Leicester Biomedical Research Centre (BRC), set up a SPIN (Specialist Pneumonia Intervention Nurse) service – dedicated to screening for potential cases from acute medical admissions and implementing key activities rapidly.
- Completion of key interventions within 4 hours
- Rapid confirmation by chest x-ray
- Rapid scoring of disease severity
- Guided antibiotic therapy
The service comprised of two specialist pneumonia nurses working at two acute hospital sites during daytime hours.
Rapid and sustained impact
The research compared a two year ‘baseline period’ (2011/12 – 2012/13) with a similar two year period after implementation of the service (2014/15 – 2015/16).
The results were striking:
- In year 1 of providing the specialist service – the overall death rate from CAP (within 30 days of admission) was reduced from 23 per cent to 17 per cent for those seen by the nurses
- In year 2 – the death rate reduced even further to 11 per cent
- These improvements remained significant after adjustment for age and other illnesses the patients had – and for year 2015/16 – were confirmed as significantly better than expected for NHS patients by external NHS monitors
Consultant clinic burden lifted
The nurses also provide a six-week follow up x-ray service for more than 1,000 patients per year who require confirmation that the disease has fully resolved. This task was previously delivered by consultants in hospital outpatient clinics – so the service has freed up capacity for these appointments to be offered to other lung disease patients.
Outcomes also improved for those patients not personally reviewed by the SPIN team suggesting systematic learning benefits occurred. The service has now been expanded to five nurses, with the vision being that ALL patients admitted with the disease will benefit from being seen by the specialist nurses.
Dr Gerrit Woltmann, consultant respiratory physician, head of service at Leicester’s Hospitals, and member of the British Thoracic Society, said: “Pneumonia is a killer disease and causes thousands of deaths across the NHS every year. The key to better health outcomes is fast diagnosis, correct disease severity assessment and rapid and tailored treatment.
“Many NHS hospitals face problems with pneumonia mortality. The creation of our new pneumonia nursing posts to ensure rapid delivery of evidence-based care has really worked. We are now saving many more lives whilst reducing NHS costs at the same time.
“Our relatively low-cost approach means patients meet a dedicated and specialist nurse with expertise in managing their disease quickly and consistently. This takes pressure off the wider team who can deal with a wide range of other patients with lung disease admitted to the hospital.”
The SPIN service was initially funded through the NHS England Commissioning for Quality and Innovation (CQUIN) framework and supported by the NIHR Leicester BRC.
Dr Lisa Davies, Consultant lung specialist and Chair of the British Thoracic Society’s Board said: “This service shows how lung teams across UK, often under severe pressure, are successfully delivering workforce innovation to save lives.
“Looking at the national picture, we need an urgent plan on bolstering our specialist lung workforce, currently facing major shortages, to cope with the rising burden of lung disease – scaling good practice like this is definitely part of the solution, but we also need strong policies to recruit and retain specialist staff at all levels.”
Community Acquired Pneumonia (CAP) is a common and deadly condition that puts huge pressure on the NHS in winter. It is contracted outside of hospital and is caused by a bacterial infection which inflames the tissue in one or both lungs which fill up with fluid. This can cause severe breathing problems.