BTS statement on criteria for specialist referral, admission, discharge and follow-up for adults with respiratory disease

Abstract

The UK National Health Service (NHS) is developing rapidly. During this time of change there are many resource pressures on the overall healthcare system. There are also drivers being developed which aim to improve the consistency and quality of care for all patients. The British Thoracic Society (BTS) recognises these challenges and is an advocate for high quality standards in respiratory care. This statement has been developed from major evidence-based guidelines by an expert group with wider consultation including primary care colleagues in the General Practice Airways Group. It is aimed at those who commission and quality assure respiratory care as well as those involved in delivering this care. The BTS recognises that, in many areas, development of integrated care pathways and initiatives to improve care with earlier discharge from hospital, prevention of admission strategies and fast track outpatient clinics are developing with a variety of experiences. These are intended to improve the patient's experience of care, the quality of care and the effectiveness of the care provided. We hope that this statement will allow positive collaboration between primary and secondary care - and discussion between clinicians and commissioners. The areas covered pertain to the commonest causes of respiratory admission in the adult population, and are relevant no matter who refers and who manages the care of the patient. We recognise that, at times, individual uncertainties in clinical practice and balanced clinical judgement will result in practice outside the guidance. However, we hope these will be relatively few and for understandable reasons. Some areas of the statement are aimed at common problems which result in high-cost hospital admission and high health care costs; others are aimed at rarer conditions. It should be remembered that some of the rarer conditions can be a large "hidden" cost to the NHS - all of these are very important to our patients. We hope this statement will be used by: ▶ service planners and developers ▶ commissioners of respiratory services ▶ providers of unscheduled care and emergency services ▶ clinicians in primary care (medical, nursing and others) ▶ clinicians in medical assessment units. It is not aimed specifically at the following groups, but they will find it useful to read as an adjunct to the current BTS guidelines: ▶ clinicians in secondary care (medical, nursing and others) ▶ patient user groups ▶ audit and quality assurance departments. The statement provides guidance on the following clinical disease areas: ▶ asthma ▶ chronic obstructive pulmonary disease (COPD) ▶ lung cancer and mesothelioma ▶ pneumonia ▶ pulmonary embolism ▶ obstructive sleep apnoea ▶ other rarer conditions including bronchiectasis, lung fibrosis, sarcoidosis and tuberculosis. The guidance suggests the acceptable indications for: ▶ referral to a specialist respiratory clinic ▶ follow-up in a specialist respiratory clinic ▶ discharge from a specialist respiratory clinic ▶ emergency admission to hospital ▶ discharge from hospital. The BTS recognises that practice is changing in the NHS and that this statement should be seen as providing, for the first time, good practice indicators to work towards and achieve when any respiratory service redesign is considered. The BTS wishes to promote these as potentially auditable parameters for significant event analysis and quality assurance monitoring.