This quality standard covers adults (18 years and older) with a suspected or confirmed diagnosis of community‑acquired pneumonia. For more information see the pneumonia topic overview.
Pneumonia is an infection of the lung tissue. When a person has pneumonia the air sacs in their lungs become filled with microorganisms, fluid and inflammatory cells and their lungs are not able to work properly. Diagnosis of pneumonia is based on symptoms and signs of an acute lower respiratory tract infection, and can be confirmed by a chest X‑ray showing new shadowing that is not due to any other cause (such as pulmonary oedema or infarction). The NICE guideline on pneumonia classifies pneumonia depending on the source of the infection as community‑acquired or hospital‑acquired, which need different management strategies.
Every year between 0.5% and 1% of adults in the UK will have community‑acquired pneumonia. It is diagnosed in 5% to 12% of adults who present to GPs with symptoms of lower respiratory tract infection, and 22% to 42% of these are admitted to hospital, where the mortality rate is between 5% and 14%. Between 1.2% and 10% of adults admitted to hospital with community‑acquired pneumonia are managed in an intensive care unit, and for these patients the risk of dying is over 30%. More than half of pneumonia‑related deaths occur in people older than 84 years.
At any time, 1.5% of hospital patients in England have a hospital‑acquired respiratory infection, more than half of which are hospital‑acquired pneumonia and are not associated with intubation. Hospital‑acquired pneumonia is estimated to increase a hospital stay by about 8 days and has a reported mortality rate ranging from 30% to 70%. There are variations in clinical management and outcomes across the UK.
The quality standard is expected to contribute to improvements in the following outcomes:
hospital admission and re‑admission
length of hospital stay
health‑related quality of life
inappropriate antibiotic use.
NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:
Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to pneumonia. In particular, it will be important to ensure that adults with pneumonia have an understanding of how long it may take to recover as well as when they may need to seek further advice.
NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE Pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.
The quality standard for pneumonia specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole pneumonia care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to adults with pneumonia acquired in community settings.
The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality pneumonia service are listed in related NICE quality standards.
The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating adults with pneumonia should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development sources on specific types of training for the topic that exceed standard professional training are considered during quality statement development.
Quality standards recognise the important role families and carers have in supporting adults with pneumonia acquired in community settings. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.