Diagnosis and management of supraglottitis

Through its core work to review recorded patient safety events, the National Patient Safety Team were made aware of issues around the diagnosis and management of epiglottitis.

Following the death of an adult from acute epiglottitis, the Chief Medical Officer alerted the team to concerns regarding a potential lack of knowledge and awareness of the presentation and symptoms of epiglottitis in adults.

The success of the Hib vaccination programme means epiglottitis is rare in the UK, and most cases now occur in adults. Epiglottitis is regarded as a medical emergency, as a swollen epiglottis can restrict the oxygen supply. Patients who develop severe epiglottitis may require urgent intubation or tracheostomy insertion to enable them to breathe.

A review of the National Reporting and Learning System (NRLS) confirmed issues with recognition and management of acute epiglottitis, particularly in secondary care. The management issues identified were multifactorial and included: lack of clarity regarding the best clinical environment to provide care; level of acuity; safe transfers to, within, and across hospitals; difficult airway management (including where best to perform diagnostic laryngoscopy); delayed and omitted critical medication; and access to functional diagnostic equipment.

As an absence of clinical guidance for secondary care was apparent, the team engaged with ENTUK, the professional membership body representing ear, nose and throat surgery and head, neck and thyroid surgery in the UK, who agreed to develop clinical guidance.

ENTUK have now published adult acute severe sore throat management guidelines to support safer care to this group of patients. We are also supporting the dissemination of these guidelines via the Royal College of Emergency Medicine and Royal College of Physicians.

About our patient safety review and response work

The recording and central collection of patient safety events to support learning and improvement is fundamental to improving patient safety across all parts of NHS healthcare. The National Patient Safety Team identify new or under recognised patient safety risks, which are often not obvious at a local level. It does this through its core work to review patients safety events recorded on national systems, such as the National Reporting and Learning System (NRLS), the new Learn from Patient Safety Events service (LFPSE), and other sources.

In response to any newly identified risks, we develop advice and guidance, such as National Patient Safety Alerts, or work directly with partners as in the example above, to support providers across the NHS to take the necessary action to keep patients safe.

You can find out more about our processes for identifying new and under recognised patient safety issues on our using patient safety events data to keep patients safe and reviewing patient safety events and developing advice and guidance web pages.

You can also find more case studies providing examples of this work on our case study page.