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Chest Infection Audit Specification
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Specification of the Audit

Title: PCRS-UK audit of patients diagnosed in primary care with chest infection

Aims of audit:

To determine baseline quality of diagnosis and management of patients presenting with symptoms suggestive of chest infections in primary care.

Audit Criteria:

To include history, clinical examination findings, treatment, management and follow up of patients diagnosed with chest infections.

Audit standards

In all patients diagnosed with a chest infection in primary care

  1. Presence of any underlying chronic condition (including asthma, COPD, diabetes, IHD, other) will be elicited by the clinician from the history or medical records in least 90% of patients.
  2. The duration of the presenting symptoms will be recorded in at least 90% of cases.
  3. A relevant physical examination (including examination of the chest, blood pressure, respiratory rate, assessment of level of confusion) will be performed and recorded in 100% of patients.
  4. Temperature measured (or reported by patient) will be recorded in at least 80% of patients.
  5. 100% of patients will have a record of a diagnosis in the patient notes.
  6. Treatment:
    1. 100% of patients with CAP and a CRB-65 score of 1-2 will be treated with recommended antibiotics.
    2. 100% of patients with CAP and a CRB-65 score of 3-4 will be admitted to hospital as an emergency.
    3. 90% of patients with SaO2 below 92% will be referred to hospital.
  7. The medical record will reflect that > 80% patients have been advised on when and how to seek follow-up assistance (as per NiCE Guideline 69).
  8. 100% of patients will have an entry regarding the disposal of the patient (home, referral, admission, follow up arrangements made).

Additional resources

In those patients diagnosed with Community Acquired Pneumonia, the CRB-65 and abbreviated Mental Test Scores are helpful in determining severity and the need for hospital admission. To view details of these scores click here for the CRB-65 and the Abbreviated Mental Test Score.

Further reading

  1. M.L. Levy, M. Fletcher, D.B. Price, T. Hausen, R.J. Halbert, B.P. Yawn. Diagnosis of respiratory diseases in primary care . Prim Care Resp J 2006; 15(1):20-34. Available online at http://dx.doi.org/10.1016/j.pcrj.2005.10.004
  2. J Macfarlane, W Holmes, P Gard, R Macfarlane, D Rose, V Weston, M Leinonen, P Saikku and S Myint.Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community. Thorax 2001;56;109-114
  3. Feldman, C. Appropriate management of lower respiratory tract infections in primary care (2004) Primary Care Respiratory Journal, 13 (3), pp. 159-166. http://dx.doi.org/10.1016/j.pcrj.2004.02.006
  4. Nice 69
  5. Bauer, T.T., et al., CRB-65 predicts death from community-acquired pneumonia. Journal of Internal Medicine, 2006. 260(1): p. 93-101.)
  6. Woodhead, M.A., et al., The value of routine microbial investigation in community-acquired pneumonia. Respir Med, 1991. 85(4): p. 313-7.
  7. BTS CAP guideline (In press – link to be added later)
  

 

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