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Specialist nurses help halve hospital pneumonia deaths

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A specialist nurse-led service in Leicester has helped halve hospital deaths from pneumonia and could save thousands of lives each year if replicated across the NHS, say those behind the scheme.

An evaluation shows the Specialist Pneumonia Intervention Nurse (SPIN) service at University Hospitals Leicester Trust has led to a significant reduction in community acquired pneumonia – the leading cause of death in NHS hospitals.

“We are now saving many more lives whilst reducing NHS costs at the same time”

Dr Gerrit Woltmann

The service, set up by consultant respiratory physician Dr Gerrit Woltmann, has seen two specialist nurses deployed to screen patients and ensure speedy diagnosis and treatment.

The nurses, who are based at two of the trust’s hospitals, screen acute medical admissions to identify potential cases of pneumonia with key action taken within four hours.

This includes rapid confirmation of a pneumonia diagnosis by chest X-ray, swift scoring of the severity of disease and the use of guided antibiotic therapy.

Research presented at the British Thoracic Society’s winter meeting today compares a two-year period before the introduction of the service to a similar period after it was implemented.

The findings show that in 2014-15 - the first year of the new specialist services - the overall death rate from community acquired pneumonia within 30 days of admission fell from 23% to 17% for those seen by the nurses.

In 2015/16 the death rate fell even further to 11.5% and was better than expected for NHS patients, according to independent experts who looked at the results.

The improvements remain significant even when adjusted for age any other illnesses the patients had.

The nurses also provide a six-week follow-up service for more than 1,000 patients per year to check the disease has cleared up.

Previously, this was done by consultants in hospital outpatients clinics, so the service has freed up capacity meaning these appointments can now be offered to other lung disease patients.

The fact outcomes for patients not personally seen by the SPIN team have also improved suggest the new service is having a wider impact and has led to “systemic learning”, according to its designers.

Many hospitals face problems with pneumonia mortality, explained Dr Woltmann who said the SPIN service was a inexpensive yet effective solution.

“We need strong policies to recruit and retain specialist staff at all levels”

Dr Lisa Davies 

“The creation of our new pneumonia nursing posts to ensure rapid delivery of evidence-based care has really worked,” he said. “We are now saving many more lives whilst reducing NHS costs at the same time.”

It also had the benefit of taking the pressure off other staff – freeing them up to see other lung patients, he added.

“Our relatively low-cost approach means patients meet a dedicated and specialist nurse with expertise in managing their disease quickly and consistently,” he said.

“This takes pressure off the wider team who can deal with a range of other patients with lung disease admitted to the hospital,” Dr Woltmann added.

He said: “This service shows how lung teams across UK, often under severe pressure, are successfully delivering workforce innovation to save lives.”

Dr Lisa Davies, consultant lung specialist and chair of the British Thoracic Society’s board, said the scheme was an excellent example of staff innovation despite ongoing pressures.

“This service shows how lung teams across the UK, often under severe pressure, are successfully delivering workforce innovation to save lives,” she said.

However, she went on the stress the urgent need to bolster the specialist lung workforce, which is currently facing major shortages.

“Scaling good practice like this is definitely part of the solution, but we also need strong policies to recruit and retain specialist staff at all levels,” she said.

The SPIN service was initially funded through the NHS England Commissioning for Quality and Innovation (CQUIN) framework and supported by the National Institute for Health Research Biomedical Research Centre in Leicester.

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