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Pleural infection and pneumonia
S65 Early supported discharge scheme (ESDS) for pneumonia & lower respiratory tract infection (LRTI): are there enough suitable patients?
  1. A Collins1,
  2. S Wilks2,
  3. D Wootton2,
  4. A Wright3,
  5. L Davies2,
  6. J Hadcroft4,
  7. S Gordon5
  1. 1NIHR Biomedical Research Centre, Royal Liverpool University and Broadgreen Hospitals Trust, Liverpool, UK
  2. 2University Hospital Aintree, Liverpool, UK
  3. 3CLRN, Liverpool, UK
  4. 4Royal Liverpool and Broadgreen University Teaching Hospital, Liverpool, UK
  5. 5Liverpool School of Tropical Medicine & Royal Liverpool and Broadgreen University Hospital, Liverpool, UK

Abstract

Background Despite the fact that ∼75% of community acquired pneumonia (CAP) is managed in the community, admissions for pneumonia, influenza & LRTI account for more than 2.3 million bed days/yr in England alone. Strategies to enable increased outpatient care must be safe, acceptable to patients & potentially reduce costs & improve patient outcomes. Current guidelines suggest that patients with CURB-65 >2 require hospitalisation, but up to 70% of pneumonia admissions are CURB-65 =2. Median length of stay (LOS) for CAP is 6–12.9 days. Despite low risk-scores patients may have a prolonged hospital admission due to other reasons for example, comorbidities & social issues.

Aim To retrospectively investigate the number of patients that could potentially be discharged with an ESDS, akin to current COPD schemes.

Method We performed a retrospective audit of 54 case-notes randomly selected from 462 admissions (with J-codes 10–18) over a 2-month period. Certain inclusion & exclusion criteria were used to assess scheme eligibility (appropriate diagnosis) & scheme suitability.

Results Mean age=70 yrs old (range 18–96). Mean CURB-65=1.93 (range 0–4). Of CAP pts (n=38) CURB 0–1=32%, 2=26%, 3–5=34%. Comorbidities were common; COPD (16/54), cancer (13/54), IHD (10/54), dementia (8/54). Eligible for ESDS n=46, suitable n=22/46 (48%). 84% of those eligible for ESDS had comorbidities, but these did not necessarily make patients unsuitable for ESDS. The total potential reduction in LOS with ESDS is 2.75 (1–7) days. With a conservative estimate of 2400 pneumonia admissions annually & a 10-day mean LOS, (a total of 24 000 bed days/yr), 6600 bed days/yr could be saved in our hospital trust alone. Using HES data for annual admissions with pneumonia and influenza (∼150 000/yr), this amounts to a potential saving of 412 500 bed days annually in England alone.

Conclusions This retrospective audit suggests that a proactive ESDS scheme could enable patients to be provided with high-quality safe, effective, efficient patient-centred care, tailored to their needs, in their own home. This is an opportunity to improve health policy, healthcare delivery/services & reduce admission rates; an area of major strategic importance to the NHS.

Abstract S65 Table 1

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