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British Thoracic Society Community Acquired Pneumonia audit 2011/12

British Thoracic Society Community Acquired Pneumonia audit 2011/12. Dr Wei Shen LIM Respiratory Medicine Nottingham University Hospitals NHS Trust on behalf of the BTS. Participation. 2010/11 2011/12 Total Institutions 76 129 150 Submissions 3570 5435 9005

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British Thoracic Society Community Acquired Pneumonia audit 2011/12

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  1. British Thoracic Society Community Acquired Pneumonia audit2011/12 Dr Wei Shen LIM Respiratory Medicine Nottingham University Hospitals NHS Trust on behalf of the BTS

  2. Participation 2010/11 2011/12 Total Institutions 76 129 150 Submissions 3570 5435 9005 Average/site 46 42

  3. Patient profile 2010/11 2011/12 Age (mean) 68 yrs 72 yrs Via ED 2449 (69%) 3910 (72%)

  4. Disease severity Severity (CURB65) 2010/11 2011/12 Low :0 to 1 1664 (46%) 2361 (44%) Moderate: 2 966 (27%) 1578 (29%) High:3 to 5 940 (26%) 1496 (27%)

  5. Time: admission to CXR >8 h >8 h 6-7 h 6-7 h 4-5 h <4 h 4-5 h <4 h <4 h <4 h Time to CXR <4 hrs: 83.3% v 86.4% (p<0.001)

  6. Time: admission to first antibiotics 2011/12 2010/11 >8 h >8 h <4 h <4 h 4-5 h 4-5 h Time to first antibiotics <4 hrs: 48.4% v 55.7% (p<0.001)

  7. Low severity (CURB65 0 to 1) antibiotics * p=0.0016

  8. Moderate severity (CURB65 2) antibiotics

  9. High severity (CURB65 3 to 5) antibiotics

  10. Adherence to local CAP Guidelines 54.8% 52% p = 0.0126

  11. BTS National CAP Audit 72 institutions, n=5240 62% - combination betalactam/macrolide antibiotics *p = 0.025 Low: OR 0.8 (0.5 to 1.16) Mod: OR 0.54 (0.4 to 0.7)* High: OR 0.76 (0.6 to 0.96)* *p<0.001 Rodrigo C, Thorax 2012

  12. Clinical outcomes 2010/11 2011/12 p value In-patient mortality 20.4% 19.5% 0.30 LOS (median) 5 days 5 days Readmitted, 30d 322(9%) 579 (10.7%) 0.012 Died, 30d from d/c 108 (3.8%) 164 (3.8%)

  13. Areas to improve • Time to CXR • Time to antibiotics • Appropriate antibiotics BTS/NHS Improvement COPD and CAP Care Bundles

  14. British Thoracic Society • CAP Care Bundle • COST • CXR < 4 hours • O2 assessment < 1 hour • Severity assessment (CURB65 score) • Timely & targeted antibiotics < 4 hours

  15. Time: admission to first antibiotic Time to first antibiotic <4 hrs: 59.4% v 63.4% (p=0.001)

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