Ambulatory Emergency Care Pathways. Community Acquired Pneumonia & Lower Respiratory Tract Infection

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Shavonne Walsh
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1 Ambulatory Emergency Care Pathways Community Acquired Pneumonia & Lower Respiratory Tract Infection Effective Date: September 2011

2 Content Summary Ref Title Description 1 Condition Details Identifies pathway details and clinical sign-off 2 Pathway Algorithm Identifies the pathway to follow to identify patients suitable for Ambulatory Care 3 Patient Criteria Criteria for patients appropriate for the pathway 4 Patient Information Identifies Patient Information leaflets for issue to patients regarding their pathway 5 KPIs Identifies how the pathways are measured

Patient Criteria Criteria for patients appropriate for the pathway 4 Patient Information Identifies Patient

3 1. Condition Details Community Acquired Pneumonia Condition Details Summary HRG/ICD-10 Codes Data (Baseline using 2010/11 outturn) DZ11C, DZ11B, DZ11B / J100, J110, J120, J121, J122, J128, J129, J13X, J14X, J153, J154, J157, J158, J159, J160, J168, J181, J188, J189 Total Patients per Month (Avg) Bed Days Utilised per Month (Avg) Number of Beds Utilised per Month (Avg) 0.73 Average Length of Stay 5.22 Potential Percentage suitable for ambulatory care 10-30% 1: Pat hw ay Det ails De Lower Respiratory Tract Infection Condition Details Summary HRG/ICD-10 Codes Data (Baseline using 2010/11 outturn) DZ22C, DZ22B, DZ23C, DZ23B / J200, J201, J202, J203, J204, J205, J206, J207, J208, J209, J22X, J180 Total Patients per Month (Avg) Bed Days Utilised per Month (Avg) Number of Beds Utilised per Month (Avg) 0.22 Average Length of Stay 3.34 Potential Percentage suitable for ambulatory care 30-60%

4 Sign Off: Pathway Designed by Clinical Subject Matter Expert Signed Print Pathway Approved by Specialty Lead Signed Print Pathway Authorised by Divisional Director Signed Print

5 2. Pathway Algorithm Patient Presents with suspected: Community Acquired Pneumonia or Lower Respiratory Tract Infection History & Examination (Including basic observations) Investigations Chest X - Ray, ECG, ABG, FBC, CRP, U&E, Sputum Sample, Blood Cultures (within 4hrs of Admission), ( CURB 65 Score ) Please note: the APD check box must be ticked when a patient has been put on the AEC Pathway, whether admitted or discharged. Red Flags Does Chest X -Ray Confirm CAP? Yes CURB 65 Score >2 or More Yes ADMIT No Clinical Criteria to Consider Prior to Ambulatory Care Patient is Haemodynamically Stable, SaO2 >92% on Room Air & Review by Middle Grade or above is satisfactory No Issues Addressed Same Day No Yes Prescribe & Administer Antibiotics (as per Trust Antibiotics Guidelines for CAP/LRTI) Discharge Patient Issue Patient Info (Include Smoking Cessation Advice) Supply appropriate ABx Course Arrange Clinic F/Up for 4-6 Weeks (D/C Letter Faxed to Respiratory Office on 2713) Letter to GP

whether admitted or discharged. Red Flags Does Chest X -Ray Confirm CAP?

6 3. Patient Criteria Red Flags - Exclude the following Patients and Admit: CURB 65 Score >2 or More Clinical Criteria that requires addressing same day for AECP, else Admit / Reconsider Diagnosis: Patient is Haemodynamically Stable SaO2 >92% on Room Air Review by Middle Grade or above is satisfactory

day for AECP, else Admit / Reconsider Diagnosis: Patient is

7 4. Patient Information Community Acquired Pneumonia Introduction What is Pneumonia? You have been diagnosed with pneumonia. This is an infection of the lungs most commonly caused by bacteria. Your pneumonia has been assessed by the hospital team and is safe to be treated at home with tablet antibiotics. Why have you developed pneumonia? Anybody can get pneumonia, including young fit adults. There are other factors that may make people more prone to it. These include: Long-standing respiratory conditions Smoking Alcohol and/or drug abuse Increasing age Other medical conditions such as diabetes, cancer and stroke AIDS How serious is it? Pneumonia can range from mild to life threatening. Your pneumonia has been assessed as less severe and therefore safe to treat at home. What symptoms might you suffer? Typically patients complain of cough (and you may produce discoloured sputum), breathlessness, lack of energy, fevers, loss of appetite, headaches, aches and pains, but often might have only 1 or 2 of these symptoms. What is the treatment? Antibiotics are used to kill the bacteria that usually cause the pneumonia. You should drink plenty of fluids to prevent dehydration. Paracetamol or Ibuprofen can be taken to help control fever and pain. If you are a smoker then you should try to stop.

Anybody can get pneumonia, including young fit adults. There are other factors that may make people more prone to it.

8 When will you recover? Antibiotics usually work well and you should expect the symptoms to settle over a few days. It may take several weeks for your energy levels to recover and you may feel exhausted performing tasks that you can normally easily achieve. You should expect to make a complete recovery without long term effects. What to do if you are not improving? If the symptoms are not settling you should see your GP. If the symptoms are getting worse, then you should return to the Accident and Emergency department. Is there any follow-up? We will advise your GP to repeat the chest X-ray in 4 to 6 weeks unless a follow-up in the chest clinic has already been arranged.

You should expect to make a complete recovery without long term effects. What to do if you are not improving? If the symptoms are not settling you should see your GP.

9 Lower Respiratory Tract Infection Introduction Lower Respiratory Tract Infection (LRTI) A lower respiratory tract infection is any infection of the airways and/or lungs. It is usually caused by a virus. Why have you developed a LRTI? LRTIs can spread in several ways. If you have an infection such as a cold, tiny droplets of fluid containing the cold virus are launched into the air whenever you sneeze, cough or speak. If these are breathed in by someone else, they may also become infected. Infections can also be spread through direct and indirect contact. For example, if you have a cold and you touch your nose or eyes before touching someone else, you may pass the virus on to them. How serious is it? Most LRTIs will pass without the need for treatment. What symptoms might you suffer? The main symptom of a lower LRTI is also a cough, although it is usually more severe and you may bring up phlegm and mucus. Other possible symptoms are a tight feeling in your chest, increased rate of breathing, breathlessness and wheezing. What is the treatment? You can treat your symptoms at home by taking over-the-counter painkillers, drinking plenty of fluids and resting. Antibiotics are not usually recommended for treating LRTIs, because most are not caused by bacteria. When will you recover? The symptoms of an upper LRTI usually pass within one to two weeks. What to do if you are not improving? If at any point you are concerned about your, please see your GP or contact NHS Direct on The information in this leaflet is not intended to replace the advice given to you by your doctor or the service looking after you.

If you have an infection such as a cold, tiny droplets of fluid containing the cold virus are launched into the air whenever you sneeze, cough or speak.

10 5. KPIs Community Acquired Pneumonia KPIs Core KPIs Description Reduction in the number of patients requiring a stay of more than 24 hours (i.e. a 0-Day LoS) Reduction in the Avg number of Bed Days utilised for the condition How it will be measured Baseline (2010/11) At Min % At Max % PAS PAS Reduction in Bed Numbers PAS Other KPIs Scope Governance Scope: Patients entering the AECP Pathway at St. Peter s Hospital Governance: Reports to the Unscheduled Care Programme Board and Divisional Performance Review Meetings Above Min and Max figures are part year effects for 2011/12 based on month of implementation

Bed Days utilised for the condition How it will be measured Baseline (2010/11) At Min % At Max % PAS 608 30 91 PAS 3176 159 476 Reduction in Bed Numbers PAS 8.

11 Lower Respiratory Tract Infection KPIs Core KPIs Description Reduction in the number of patients requiring a stay of more than 24 hours (i.e. a 0-Day LoS) Reduction in the Avg number of Bed Days utilised for the condition How it will be measured Baseline (2010/11) At Min % At Max % PAS PAS Reduction in Bed Numbers PAS Other KPIs Scope Governance Scope: Patients entering the AECP Pathway at St. Peter s Hospital Governance: Reports to the Unscheduled Care Programme Board and Divisional Performance Review Meetings Above Min and Max figures are part year effects for 2011/12 based on month of implementation

Reduction in Bed Numbers PAS 2.66 0.07 0.13 Other KPIs Scope Governance Scope: Patients entering the AECP Pathway at St.

Pneumonia. Pneumonia is an infection that makes the tiny air sacs in your lungs inflamed (swollen and sore). They then fill with liquid.

Pneumonia. Pneumonia is an infection that makes the tiny air sacs in your lungs inflamed (swollen and sore). They then fill with liquid. Pneumonia Pneumonia is an infection that makes the tiny air sacs in your lungs inflamed (swollen and sore). They then fill with liquid. People with mild (not so bad) pneumonia can usually be treated at