NHS SCOTLAND
Providing advice about the status of all newly licensed medicines
Pneumonia is an acute lower respiratory tract infection (LRTI) associated with fever, recent onset of symptoms, signs of a respiratory illness and/or new abnormalities on a chest radiograph.
Community acquired pneumonia (CAP) is a common cause of morbidity, mortality and consumption of hospital resources in the UK. CAP represents a key acute medical illness of concern to physicians in primary and secondary care, patients and health care planners.
In the UK, the direct annual healthcare cost of CAP is ca. £441million.
In Scotland, 30-day mortality rate (from admission) from CAP is on average 20% (ISD Scotland, 2008).
|
Country |
Adult admission rate/year for pneumonia |
|
UK and Canada |
1 per 1,000 |
|
Spain |
2.6 per 1000 |
|
USA |
4 per 1000 |
There are evidence-based markers of severity at presentation and of stabilisation in response to treatment that can be used to support clinical decisions about processes of care (see SIGN 59 Section 5). Nonetheless, in Scotland a large prospective audit of 205 patients, admitted with CAP to 2 hospitals in Tayside, showed significant gaps in the quality of care. In particular there was a lack of uniformity regarding the amount of oxygen prescribed, with evidence of poor case record and drug prescription chart documentation related to oxygen therapy.
Two well-controlled studies have shown significant improvement in processes of care and mortality associated with the introduction of care pathways for CAP. These data indicate that CAP represents an important and common acute medical illness for which there is evidence of considerable variation in practice as well as significant morbidity and mortality.
Measurement of a core set of evidence-based, well-defined and readily measurable performance indicators offer a means of targeting key interventions and evaluating their impact.