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Tiwari D, Kitchener R, Richards-Taylor S, Whiffen M, Allen S. Improving mortality outcomes in aspiration pneumonia: training, technology and teamwork. BMJ Open Qual 2022; 11:bmjoq-2021-001553. [PMID: 35217592 PMCID: PMC8883260 DOI: 10.1136/bmjoq-2021-001553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/08/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Divya Tiwari
- Department of Older People Services, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK .,Faculty of Healh & Social Sciences, Bournemouth University, Poole, UK
| | - Ruth Kitchener
- Department of Older People Services, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Sebastian Richards-Taylor
- Department of Older People Services, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Martina Whiffen
- Department of Older People Services, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Stephen Allen
- Department of Older People Services, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK.,Faculty of Healh & Social Sciences, Bournemouth University, Poole, UK
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Richards-Taylor S, Kitchener R, Whiffen M, Tiwari D. 146 Improving Outcomes in Aspiration Pneumonia: A Collaborative Approach. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Aspiration pneumonia is a major cause of morbidity and mortality especially in older adults. Our Trust recorded higher than expected mortality ratios in this group of patients. Aim To investigate reasons behind higher than expected mortality and improve outcomes. Intervention We developed a collaborative approach of investigating mortality in aspiration pneumonia with joint input from Speech and Language (SALT) specialists.
Method
We conducted structured retrospective review of annual mortality in aspiration pneumonia in 3 PDSA (plan, do, study, and act) cycles in 2015/18/20. We collected data on clinical care, diagnostic accuracy, SALT referral/input, feeding at risk discussion, communication with primary care. We monitored mortality ratios on national systems.
Results
We improved clinical and nursing care by auditing mouth care, bed elevation and safe feeding. We also developed electronic-SALT referral form to improve timings for the reviews (first PDSA cycle). SALT team developed “feeding at risk proforma” to formalise risk feeding where safe swallow plan was not possible (second PDSA cycle). We modified discharge summaries and made this a multidisciplinary document in the Trust so that SALT can communicate feeding plans to primary care (third PDSA cycle). Mortality ratios improved significantly in this period from Relative risk of 152 (higher than expected range) in 14/15 to 86 (within expected range) in 19/20.
Conclusion
We have demonstrated significant improvement in hospital mortality ratios from aspiration pneumonia and therefore improved care by collaboratively working with SALT team and bringing changes in stepwise manner. Multidisciplinary mortality reviews are key to improving outcomes for our patients.
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Affiliation(s)
- S Richards-Taylor
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
| | - R Kitchener
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
| | - M Whiffen
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
| | - D Tiwari
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
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