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Abstract
Background Bronchiectasis is said to affect 100/100 000, however the true prevalence is probably significantly higher. Our previous BTS bronchiectasis audit identified that a significant service improvement was required. This led to the introduction of a home intravenous antibiotic pilot, a bronchiectasis working group, and enhanced teaching and information sharing with primary care. Despite this, these patients remain poorly served both in the community and hospital.
From 2009–13 there were 330 bronchiectasis admissions to our hospital. A significant proportion of these could have been managed in the community, substantially reducing the cost to the NHS.
Aims We are developing an integrated bronchiectasis service between hospital and community. The vision has been to create a primary and secondary care interface, utilising the usual multi-disciplinary team plus psychology and dietetic support, a ‘hospital without walls’ model and an online, multi-faceted communication tool.
Outputs We provided Pseudomonas eradication therapy (previously published – White et al. 2012) and have piloted a home intravenous antibiotic service providing treatment for exacerbations which saved 497 hospital bed days in 2013. Twenty one patients received 37 home intravenous courses; of these, 17 courses were self-administered. Overall we reduced annual bronchiectasis admissions by 30% when comparing with 2011–12, equivalent to 23 fewer admissions over the year.
We have developed an online database and clinical record tool which can be shared and updated by hospital and community alike. As well as allowing rapid communication, the database shows trend analysis, logging of microbiology/antibiotic use and is a valuable audit and research resource.
We held a recent workshop comprising CCG, community partners and hospital stakeholders. We developed a new dynamic care pathway showing a combined “community/hospital hub” which will work with partners in primary and secondary care (Figure 1). We propose that such shared care working represents a useful model for broad application elsewhere.
