As part of an initiative within the North West Strategic Health Authority to improve the quality of care, ‘quality markers’ (QMs) were measured in all adult admissions with pneumonia in all 24 Acute Trusts in the North West Region for 1 year (discharges from October 2008 to September 2009). Only adults who fulfilled a prescribed definition of ‘pneumonia’ were included. QMs were taken from a USA initiative and adapted for UK use. Patient identification was based on clinical coding. Data were recorded in each individual Trust and centrally collated.
Combined data from all trusts QMs were recorded with the following frequencies (no in parentheses is number of patients included): Oxygenation assessment within 24 h or prior to hospital arrival 96.9% (11 127), blood culture performed in the A & E prior to initial antibiotic received in hospital 58.5% (3323), smoking cessation advice/counselling given in 38.1% (2788), initial antibiotic consistent with local CAP guidelines 80.8% (6337) and initial antibiotic received within 6 h of hospital arrival 64.6% (7889). Over the four quarters of the year there was no change in the frequency (%) of oxygenation assessment (96.0, 96.1, 97.6, 98.8), initial antibiotic selection (81.9, 77.9, 80.9, 83.7), or initial antibiotic within 6 h (67.1, 64.0, 63.6, 63.5) or blood cultures performed before antibiotics (58.8, 56.3, 57.9, 62.4) but a small rise in smoking cessation advice (36.4, 32.6, 40.3, 45.5). Overall score, whether composite or appropriate did not change.
Individual trusts Of the 22 Trusts with complete results, overall score over the year was <80% in one, 80–85% in two, 85–90% in three, 90–95% in 13 and >95% in three. Comparing last with first quarter scores only five individual Trusts showed a rise in score of >5%, three a fall of >5% and all others changed less than this amount. The biggest change was in the Trust that performed worst in the first quarter. Practical problems identified included accurate case identification and case note data recording. Despite this the Advancing Quality programme is a practical way of measuring QMs in pneumonia. Further work is required to generate improvements in patient care.
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