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. 2021 Aug;8(1):e000863.
doi: 10.1136/bmjresp-2020-000863.

Specialist pneumonia intervention nurse service improves pneumonia care and outcome

Robert C Free  1 , Matthew Richardson  1 , Camilla Pillay  2 , Kayleigh Hawkes  3 , Julie Skeemer  3 , Rebecca Broughton  4 , Pranabashis Haldar  1 , Gerrit Woltmann  5   3
Affiliations

Specialist pneumonia intervention nurse service improves pneumonia care and outcome

Robert C Free et al. BMJ Open Respir Res. 2021 Aug.

Abstract

Background: A specialist pneumonia intervention nursing (SPIN) service was set up across a single National Health Service Trust in an effort to improve clinical outcomes. A quality improvement evaluation was performed to assess the outcomes associated with implementing the service before (2011-2013) and after (2014-2016) service implementation.

Results: The SPIN service reviewed 38% of community-acquired pneumonia (CAP) admissions in 2014-2016. 82% of these admissions received antibiotic treatment in <4 hours (68.5% in the national audit). Compared with the pre-SPIN period, there was a significant reduction in both 30-day (OR=0.77 (0.70-0.85), p<0.0001) and in-hospital (OR=0.66 (0.60-0.73), p<0.0001) mortality after service implementation, with a review by the service showing the largest independent 30-day mortality benefit (HR=0.60 (0.53-0.67), p<0.0001). There was no change in length of stay (median 6 days).

Conclusion: Implementation of a SPIN service improved adherence to BTS guidelines and achieved significant reductions in CAP-associated mortality. This enhanced model of care is low cost, highly effective and readily adoptable in secondary care.

Keywords: pneumonia; respiratory infection.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Schematic for admission screening of patients with CAP. Images used are in the public domain (available at https://commons.wikimedia.org and https://www.publicdomainpictures.net/en/view-image.php?image=164002). CAP, community-acquired pneumonia; CXR, chest X-ray; RTI, Respiratory Tract Infection; PACS, Picture Archiving and Communication System; MDT, Multi-disciplinary team.
Figure 2
Figure 2
(A) Crude reported pneumonia-related mortality at UHL compared to other UK hospital trusts and (B) adjusted reported pneumonia-related mortality at UHL. FY, financial years; HSMR, hospital standardised mortality ratio; SHMI, summary hospital-level mortality indicators; SPIN, specialist pneumonia intervention nursing.
Figure 3
Figure 3
One-year survival analysis comparison for community-acquired pneumonia admissions for baseline (FY 2011/2012) and SPIN (FY 2015/2016) periods: (A) 1-year Kaplan-Meir survival curves for baseline and SPIN periods and (B) Cox proportional hazards model for 1-year survival. FY, financial years; SPIN, specialist pneumonia intervention nursing.
See this image and copyright information in PMC

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