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Hospitals must take note of ‘almost unique’ high seasonal variation in lung disease

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Hospital trusts must take note of evidence showing that lung disease is “almost unique” high seasonal variation, with a rise in admissions coinciding with cold weather episodes.

Failure to tackle the surge in lung admissions over winter increases accident and emergency “misery” for all patients, according to a new report from the British Lung Foundation.

“Much of this change will be, and should be, driven by nurses”

Wendy Preston

An 80% rise in lung disease admissions to accident and emergency departments in winter plays a major part in “pushing our A&E services over the edge”, stated the charity.

Yet, only 10% of hospital trusts who responded to a Freedom of Information request made by the foundation had plans in place to make more beds available for respiratory patients, it warned.

The report – called Out in the cold: Lung disease, the hidden driver of NHS winter pressure – said a failure to address what is “clearly a predictable and obvious seasonal variation” in respiratory admissions is at the heart of “our A&E winter crisis and potentially causing patients needless harm”.

The foundation said it had analysed, for the first time, monthly hospital episodes statistics data for each of the major disease areas over the past seven years. It also examined FOI data from trusts across England on their plans for winter care.

It found that, in 2015-16, there were more than 676,000 attendances at emergency departments for respiratory conditions. Of this group, 41% of attendances resulted in a hospital admission.

“Respiratory disease is unique in its extreme seasonal variation”

British Lung Foundation report

In addition, during 2016-17, there were over 287,000 admissions for respiratory disease. Of these, 87,000 were made in the winter months, which represents 80% more admissions than in spring.

The most common causes of these admissions were pneumonia, lower respiratory tract infections (LRTIs), chronic obstructive pulmonary disease and bronchiolitis in children under five.

The foundation said its analysis had revealed that this annual fluctuation had consistently repeated over the last seven years.

Yet, despite this pattern, it warned that many hospitals had failed to adapt services to cope with the surge in respiratory admissions, creating a “significant struggle” to find available beds during winter.

It suggested many members of the public had a mistaken image of emergency departments “being filled with fractures from slippery winter conditions”.

The report stated: “Respiratory disease is unique in its extreme seasonal variation. A systematic winter surge has combined with an overall increase in respiratory admissions to become a severe problem for emergency departments in colder months.”

“Our analysis reveals that many hospitals are woefully unprepared”

Penny Woods

Without strong community care and support outside of hospital, patients felt unable to manage their condition and turned up at emergency departments frightened, stated the report, which was published by the charity today.

It recommended that discharged patients were given consistent and reliable assessment, treatment and follow up in the community to reduce the risk that they would need to be re-admitted.

Key findings from the analysis included that, during 2016-17, respiratory admissions peaked in December at 32,492 – far above the average of 10,652 for the 20 most commons disease areas.

In addition, the foundation noted that infants and children aged one to four, and older people aged 65 and above made up 71% of all respiratory admissions in 2016-17.

It also highlighted that 61.9% more people died from a respiratory condition in the winter, compared with the non-winter months, during 2016-17.

The foundation said it was “vital” to acknowledge the growing number of respiratory admissions in winter and adapt hospital services accordingly by “allocating more beds for respiratory patients”.

The Royal College of Nursing said the report “lays bare” the steep rise in lung disease admissions to hospitals in recent years and the effect the seasonal rise in admissions has on the NHS over winter.

Association of Respiratory Nurse Specialists

Charity calls for end to ‘systemic neglect’ of lung disease

Wendy Preston

Wendy Preston, head of nursing practice at the RCN, said nurses and other health professionals throughout the health service were “aware of the increase in lung disease flare-ups over winter”.

“All of us want to provide better care and treatment to people with lung disease,” noted Ms Preston in the introduction to the Out in the cold report.

But she highlighted that improvements in lung services were “often made locally by one or two committed health care professionals”. “This is not sustainable as we know approximately half of respiratory nurse specialists could retire within the next five years,” warned Ms Preston.

“It is a great shame that lung disease isn’t more of a priority within NHS reform,” she said. “Tackling the burden of lung disease for the winter months, in a timely manner will be better for patients and reduce the pressure on our committed workforce.

“Much of this change will be, and should be, driven by nurses,” she said. “Not just those working in hospitals, but the community teams who provide self-management support, who are often the first port of call for patients when conditions flare-up and are the overlooked wrap around care they need when they come out of hospital.

“And, of course, it’s nurses who will be giving out most of the flu jabs this winter,” she added.

British Lung Foundation

Nurses urged to help find undiagnosed cases of lung disease

Penny Woods

Dr Penny Woods, chief executive of the British Lung Foundation, said: “Year after year we are seeing an influx of patients admitted to A&E with respiratory conditions.

“Our analysis reveals that many hospitals are woefully unprepared,” she said. “A more seasonal approach to supporting people with lung disease will reduce needless attendances and admissions.”

She added: “Government and NHS England need to take on board measures to tackle this seasonable and predictable crisis and support a Taskforce for Lung Health.”

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