Respiratory Medicine, Royal Derby Hospital, Derby, Derby, UK
Respiratory Medicine, Royal Derby Hospital, Derby, Derby, UK.
BMJ Open Qual. 2020 Dec;9(4). doi: 10.1136/bmjoq-2020-001102.
Young people and adults diagnosed with an HIV indicator condition should be offered an HIV test (NICE [National Institute of Clinical Excellence] guidance). Community-acquired pneumonia (CAP) is considered to be an HIV indicator condition as it has an undiagnosed HIV prevalence of 0.76%. We observed however, that the offer of HIV testing to patients with radiologically diagnosed CAP remained low even after a senior respiratory physician review. Our aim was to improve the percentage of patients being offered an HIV test with CAP requiring hospital admission across four acute medical wards at Royal Derby Hospital within 12 months. We identified several key steps in the process. These included the identification of CAP, the role of the medical clerking team and the respiratory infections nursing team that manage pneumonia admissions. After collecting baseline data and staff interviews, we conducted seven plan-do-study-act (PDSA) interventions. These included; iterative communication, educational interventions, system changes that involved a direct HIV test offering by our respiratory infection team and the addition of an HIV test to the electronic CAP bundle. Data collected from 177 patients were analysed over a period of one year. The main outcome measure of the project 'Did patients with a diagnosis of CAP on admission have a documented HIV test offered?' improved from 28% during the first cycle of data collection to 76.4% during the final cycle. Patients were more likely to be offered an HIV test if they had no comorbidity compared with those with a diagnosis of asthma or chronic obstructive pulmonary disease. Our most impactful PDSA interventions were the respiratory infection nurses directly offering an HIV test to patients and adding HIV to the electronic ordering CAP bundle. Our quality improvement programme has shown that educational, communication and system changes can help improve the uptake of HIV testing. Education on HIV testing is now part of our induction programme for new doctors and we are using a new CAP bundle to help streamline the request of HIV testing at the first clinician clerking. Our dedicated respiratory infection nursing team also ensures that patients with CAP have a documented offer of an HIV test.
年轻人和被诊断出 HIV 指示性疾病的成年人应接受 HIV 检测（NICE [国家临床卓越研究所]指南）。社区获得性肺炎（CAP）被认为是一种 HIV 指示性疾病，因为它有未确诊的 HIV 患病率为 0.76%。然而，我们观察到，即使在高级呼吸科医生审查后，放射学诊断为 CAP 的患者接受 HIV 检测的比例仍然很低。我们的目标是在 12 个月内提高 Royal Derby 医院的四个急症内科病房中需要住院治疗的 CAP 患者接受 HIV 检测的比例。我们确定了该过程中的几个关键步骤。这些步骤包括 CAP 的识别、医疗文员团队和管理肺炎入院的呼吸感染护理团队的作用。在收集基线数据和员工访谈后，我们进行了七项计划-执行-研究-行动（PDSA）干预措施。这些措施包括：反复沟通、教育干预、涉及我们呼吸感染团队直接提供 HIV 检测以及在电子 CAP 套餐中添加 HIV 检测的系统变更。在一年的时间里，对 177 名患者的数据进行了分析。该项目的主要结果测量指标“入院时被诊断为 CAP 的患者是否接受了记录在案的 HIV 检测？”从第一轮数据收集的 28%提高到了最后一轮的 76.4%。如果患者没有合并症，与患有哮喘或慢性阻塞性肺疾病的患者相比，他们更有可能接受 HIV 检测。我们最具影响力的 PDSA 干预措施是呼吸感染护士直接向患者提供 HIV 检测，并将 HIV 添加到电子订购 CAP 套餐中。我们的质量改进计划表明，教育、沟通和系统变更有助于提高 HIV 检测的采用率。现在，HIV 检测教育是我们新医生入职培训的一部分，我们正在使用新的 CAP 套餐来帮助简化一线临床医生的 HIV 检测请求。我们专门的呼吸感染护理团队还确保 CAP 患者有记录的 HIV 检测建议。
