Quality statement 3: Chest X‑ray and diagnosis within 4 hours of hospital presentation

Quality statement

Adults with suspected community‑acquired pneumonia in hospital have a chest X‑ray and receive a diagnosis within 4 hours of presentation.

Rationale

When community‑acquired pneumonia is suspected in adults, it is important that a clinical assessment sequence is carried out. If the person presents at hospital, assessment should include performing and reviewing a chest X‑ray, to help make a timely diagnosis in line with the 4‑hour patient processing targets in A&E departments. This will ensure that treatment is given to adults with pneumonia as quickly as possible and that those who do not have community‑acquired pneumonia are not given inappropriate antibiotic treatment.

Quality measures

Structure

Evidence of local arrangements and processes to ensure that adults with suspected community‑acquired pneumonia in hospital have a chest X‑ray and receive a diagnosis within 4 hours of presentation at hospital.

Data source: Local data collection.

Process

a) Proportion of diagnoses of community‑acquired pneumonia in adults in hospital at which the adult has a chest X‑ray within 4 hours of presentation at hospital.

Numerator – the number in the denominator for which a chest X‑ray was carried out within 4 hours of presentation at hospital.

Denominator – the number of diagnoses of community‑acquired pneumonia in adults.

Data source: Local data collection.

b) Proportion of diagnoses of community‑acquired pneumonia in adults in hospital which are made within 4 hours of presentation at hospital.

Numerator – the number in the denominator for which a diagnosis was made within 4 hours of presentation at hospital.

Denominator – the number of diagnoses of community‑acquired pneumonia in adults in hospital.

Data source: Local data collection.

Outcome

Inappropriate antibiotic use.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care services) ensure that adults with suspected community‑acquired pneumonia in hospital have a chest X‑ray and receive a diagnosis within 4 hours of presentation at hospital.

Healthcare professionals (such as hospital doctors and nurse practitioners) arrange a chest X‑ray for adults with suspected community‑acquired pneumonia in hospital, and confirm or rule out a diagnosis of community‑acquired pneumonia within 4 hours of presentation at hospital.

Commissioners (clinical commissioning groups) commission services in which adults with suspected community‑acquired pneumonia in hospital have a chest X‑ray and receive a diagnosis within 4 hours of presentation at hospital.

What the quality statement means for patients, service users and carers

Adults with suspected pneumonia who go to hospital have a chest X‑ray and are diagnosed within 4 hours of presentation at hospital.

Source guidance

Pneumonia in adults: diagnosis and management (2014) NICE guideline CG191, recommendation 1.2.8 (key priority for implementation)

Definition of terms used in this quality statement

Suspected community‑acquired pneumonia

Community‑acquired pneumonia is acquired outside hospital. Pneumonia that develops in a person living in a nursing or residential home is included in this definition. It is suspected in adults who have symptoms and signs of lower respiratory tract infection, and diagnosed in adults who, in the opinion of the doctor and in the absence of a chest X‑ray, are likely to have community‑acquired pneumonia. Symptoms and signs include, but are not limited to, one or more of the following: fever, shortness of breath, cough, pleuritic chest pain, increased respiratory rate or work of breathing, and localised crepitations heard on auscultation of the person's chest.

Pneumonia that develops in people who are immunocompromised, and terminal pneumonia associated with another disease are not included.

[Pneumonia in adults (2014) NICE guideline CG191 and expert opinion]

Equality and diversity considerations

Adults with pneumonia or their carers who have difficulty speaking or understanding English should have access to an interpreter or advocate if needed to ensure that they understand the diagnosis.