1 Specialist Registrar EM & Simulation Fellow, Hull Royal Infirmary

1. Care Bundling Reduces Mortality in Pneumonia Care - Our Experience Sundararaj Manou1 Ben Rayner2 AlisonLovatt3 Methods: We compared the percentage of patients receiving all four components of the care bundle as well as mortality rates before and after our educational intervention A retrospective audit (September ’12) was done to assess of our performance. Pilots of various interventions, education, prompt sheet, performance feedback were undertaken. We introduced the use of a stamp size prompt stickers attached to the notes of all patients who presented with respiratory complaints at triage. Posters were displayed in prominent areas in the department to reinforce the message. Monthly face to face teaching sessions were undertaken to increase awareness in the clinical team. All members of the team received feedback on our performance via e-mail monthly. Introduction: Community acquired pneumonia is the fourth leading cause of death in the United Kingdom. The recommendations and guidance from British thoracic society have lead to a reduction in the morbidity & mortality but there is still room for improvement. We introduced the use of Pneumonia Care bundle ‘COST’ (1) approach to all patients admitted through Emergency department, monitoring our performance and its effect on Mortality. COST- Chest x-ray, Oxygen assessment, Severity score and Treatment. Results: TheInitial audit showed 40% patients with pneumonia presenting to our department received all the components of the bundle. After introduction of the interventions the compliance improved to 90%. The mortality from Pneumonia in patients presenting to our department dropped from 30% in the period September 2011 to February 2012 to 23% in the same period the following year (September 2012-February 2013)- A drop of 7% within 6 months of implementation of the care bundle. 75 lives saved in a short period of 6 months. OR 0.69(CI 95% 0.56-0.84). Conclusion: Implementing care bundles can lead to reductions in death rates in the clinical diagnostic areas targeted and in the overall hospital mortality rate (2). The ‘COST’ care bundle approach in Pneumonia care decreased mortality in patients admitted to hospital from our Emergency Department. We have extended the implementation of the care bundle to all adult patients with pneumonia admitted to all departments of the hospital. The compliance and outcome of the use of care bundle is continuously measured. Prompt Education References: 1.British Thoracic Society and NHS Improvement, COPD and Community Acquired Pneumonia Care Bundles July 2012 2. Robb E, Jarman B et.al.: Using care bundles to reduce in‐hospital mortality: quantitative survey: BMJ 2010;340:c1234 3. Guidelines for the management of community acquired pneumonia in adults: update 2009: British Thoracic Society Community acquired pneumonia in adults guideline group. Thorax October 2009: volume 64: supplement 3 1 Specialist Registrar EM & Simulation Fellow, Hull Royal Infirmary 2 Consultant Emergency Medicine, Hull Royal Infirmary 3 Director of Patient Safety, Hull Royal Infirmary