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Clinical challenges in diagnosing and managing respiratory infection
P244 Adherence with department of health guidelines for the management of pandemic H1N1 influenza in secondary care
  1. M M Khan,
  2. R B Gore,
  3. S J Fowler
  1. Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK


Background Prior to the 2009 swine flu pandemic, there was uncertainty about the expected incidence, morbidity and mortality from the disease. The Department of Health (DoH) compiled guidelines for assessment and management of children and adults admitted to hospital with suspected H1N1 infection.

Objectives We evaluated whether adults with suspected H1N1 infection were appropriately diagnosed, investigated and managed within an NHS Foundation Trust during a period of maximal incidence when DoH guidance was accessible, with the aim of improving care for patients during future pandemic flu outbreaks and utilising hospital resources efficiently.

Methods Patient notes of suspected cases of adult H1N1 infection between July and December 2009 were retrospectively reviewed to identify how many met the diagnostic criteria, underwent relevant investigations and were prescribed a neuraminidase inhibitor as compared with DoH guidelines. The relationship between the initial consultant's diagnosis and the final diagnosis was also considered.

Results Seventy cases of suspected swine flu were identified, and full documentation was available for review in 61 of these. All patients were tested for swine flu and overall 26% of patients were H1N1 positive, including 6% of those patients who did not fulfil the diagnostic criteria. Of patients clinically suspected of having swine flu 34 (56%) did not fulfil the diagnostic criteria, although two of those. were found to be H1N1 positive. Minimum recommended investigations were performed as follows; routine bloods and chest x-ray in 85%; blood cultures in 33%; sputum cultures in 15%; and urinary pneumococcal antigen testing in 3%. Antiviral medication was not prescribed in 31%of patients suspected of having swine flu. In 74% of the cases, the initial consultant's diagnosis matched the final diagnosis; this was true for 70% of the patients who were H1N1 positive.

Conclusions Increased awareness of the available guidelines is required to optimise diagnosis and management, and minimise the likelihood of potentially unsafe, incorrect diagnoses. This requires education of healthcare staff of available guidance, and further audit following the next outbreak of pandemic flu with the aim of safely and efficiently guiding clinical practice.

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