There are a range of interventions that we have identified which are likely to have a significant impact on reducing premature mortality, but which do not sit within a discrete pathway of care. Further details are set out below.
- 10.1 Ensure compliance with the ‘Sepsis Six’ care bundle
- 10.2 Implement the British Thoracic Society’s care bundle for community-acquired pneumonia
- 10.3 Ensure providers adhere to NICE guidance and the NICE Quality Standard for the prevention of venous thromboembolism (VTE)
- 10.4 Ensure providers adhere to NICE guidelines on Acute Kidney Injury
Suggested action: Commissioners to use contracting levers to promote compliance with the ‘Sepsis Six’ care bundle by providers.
Issue: The British Thoracic Society indicates that age-standardized incidence of admission to hospital for community acquired pneumonia increased by 34 percent from 1.48 to 1.98 per 1000 population between 1997-1998 and 2004-2005 in England. The reported mortality of adults hospitalised with community acquired pneumonia in the UK has varied between 5.7 percent and 14 percent.
Suggested action: Commissioners to use contracting levers to promote compliance with the British Thoracic Society’s care bundle for community acquired pneumonia which aims to improve administration of antibiotics within 4 hours of admission to hospital.
Issue: With an incidence rate of 1-2 per 1,000 of the population, VTE is a significant cause of mortality, chronic ill-health and disability in England. One in twenty people will have VTE during their lifetime. It is estimated that as many as half of all cases of VTE are associated with hospitalisation and that around two thirds of these are preventable. National statistics show that there are currently around 6000 deaths from VTE each year in England.
Suggested action: Commissioners to use contracting levers to ensure compliance with NICE guidance for the prevention of VTE in patients admitted to hospital; the requirement to perform local audits of the percentage of those assessed to be at risk for VTE who receive appropriate prophylaxis and undertake root cause analysis of all confirmed cases of hospital-associated VTE; compliance with the NICE Quality Standard for VTE prevention.
Issue: AKI is associated with around 100,000 deaths in England per annum (though in most cases, it is not the primary cause) and 1 in 5 emergency admissions are associated with AKI.
Suggested action: Commissioners to specify in contracts an expectation that providers should work towards implementing NICE clinical practice guidelines on AKI (NICE guidance CG169 AKI August 2013 and NICE guidance CG50