More people could be treated out of hospital in the NHS’s new respiratory hubs and virtual wards
Consultation launched on draft guidance for the assessment and management of acute respiratory infections in people over 16
More people could be treated out of hospital in the NHS’s new respiratory hubs and virtual wards following new NICE draft guidance on the initial assessment and management of suspected acute respiratory infections (ARIs) published today (Friday, 1 September).
The draft guideline covers diagnosing and managing suspected ARIs, including pneumonia, respiratory viruses, and flu in adults. It does not cover people with COVID-19. It aims to improve initial assessments and access to face-to-face appointments as well as the management of conditions to help reduce hospital admissions.
Acute respiratory infections have increased since the COVID pandemic and around 220,000 people are diagnosed with pneumonia in England and Wales every year. They are more common in winter and place a significant pressure on local healthcare resources.
For the first time NICE’s updated guidance includes recommendations to refer people to acute respiratory infection (ARI) hubs or acute respiratory infection virtual wards. It follows NICE recently publishing draft guidance recommending the use of virtual wards to monitor ARI patients aged 16 or over at home using digital technologies.
The updated guidance now says that if during an online consultation a person is suspected to have pneumonia, or if an adequate assessment cannot be made remotely, the person should be referred for a face-to-face assessment.
During the in-person appointment a clinical assessment will be carried out using what is known as the ‘CRB65 score’, which uses several factors including the person’s age, blood pressure and respiratory rate to help the clinician make a judgement about managing the person’s pneumonia.
The system helps to determine the risk to the patient and whether care can be safely managed at home, the new option of care at home through a virtual ward, or if in-hospital assessment and treatment is needed. It ensures that severely ill people are seen in hospital and avoids admission for those who do not need it, which is better for patients and the NHS during busy winter periods.
For people with symptoms of an ARI who present in-person at NHS services, including GP practices and walk-in centres, the guidance recommends not offering microbiological or influenza tests to determine whether to prescribe antibiotics, but instead to use a clinical assessment.
It also recommends clinicians consider a C-reactive protein (CRP) test - that can indicate the presence of infection - to help them decide whether to prescribe antibiotics to people without suspected pneumonia.
NICE’s independent appraisal committee has also recommended research is conducted on people’s views and experiences of remote consultations to help determine how effective they are.
The consultation runs until 5pm on Friday, 15 September. Details can be found on the NICE website.