Identifying Inconsistences In Inpatient Bronchiectasis Management At A Large University Teaching Hospital

Introduction: The British Thoracic Society(BTS) has published quality standards(1) that aim to reduce the spiral of deteriorating lung function through appropriate exacerbation management. Aims: This quality improvement project, which was an expansion of a prior presented project(2) assessed inpatient management against BTS quality standards; appropriate antibiotic durations (≥14 days) at least 1 sputum analysis chest physiotherapy oral mucoactive drugs Methods: Data was retrospectively collected from bronchiectasis inpatients over a three-month period using electronic records from a single large University Teaching Hospital. Results: 66 patient admissions were identified, 34 were diagnosed with an ‘infective exacerbation of (IE) bronchiectasis’ while others included alternative respiratory infections. 50% of patients received ≥14 days antibiotics, 70% received chest physiotherapy, 55% had ≥1 sputum sample(s) collected and 62% commenced or continued carbocisteine. Patients diagnosed with an ‘IE bronchiectasis’ or admitted to a respiratory ward were more likely to receive optimal exacerbation management. Conclusions: The use of the nomenclature ‘IE bronchiectasis’ starkly influenced patient management despite all patients fulfilling criteria for infective exacerbation management.(1) Repeated cycles show overall improvements in practice, except sputum collection, reinforcing the sputum haters v/s sputum lovers divide even within the respiratory community. References: T Hill A et al. British Thoracic Society Guideline for bronchiectasis in adults. Thorax 2019;74:1-69. Gray A et al. Bronchiectasis quality improvement project. ERJ Sep 2018, 52 (suppl 62) PA794