SP 6.08 A Quality Improvement Project to Improve Compliance with Follow-Up Chest X-Ray Guidance for Pneumonia on a General Surgery Ward
Alexandra Whitworth, Raji Lallie, Adriana Repanova, Laura Boomaars, Christie Swaminathan, Muhammad S SajidAbstract
Objectives
National guidance recommends consideration of a follow-up chest X-ray (CXR) 6–8 weeks after inpatient treatment for pneumonia in patients at higher risk of underlying malignancy. This quality improvement project aimed to assess compliance with follow-up CXR guidance for patients admitted with pneumonia under general surgery and identify areas for improvement in discharge documentation.
Methods
A retrospective review was conducted of patients admitted under general surgery with either community-acquired or hospital-acquired pneumonia. Inclusion criteria were: admission under general surgery, CXR reported as infective changes, and risk factors warranting consideration of follow-up imaging (age >50 years and smoking history). Data were collected for 25 patients. Discharge summaries were reviewed to determine whether follow-up CXR was documented or arranged. Clinical context was considered when assessing appropriateness, including frailty, respiratory history, and normal admission imaging.
Results
Of 25 patients identified, 24 met criteria for consideration of follow-up CXR. Only 2 patients (8%) had follow-up imaging documented or arranged. One patient was discharged to hospice care, where follow-up imaging was inappropriate. Of the remaining cohort, 10 patients met NICE criteria for follow-up imaging, while a further 12 could reasonably have been considered depending on clinical context and patient preference. Overall, compliance with guidance was low, with follow-up imaging frequently omitted from discharge summaries.
Conclusions
Follow-up CXR documentation for pneumonia patients under general surgery was poor despite clear guidance. Simple interventions, such as discharge summary prompts or junior doctor education, may improve compliance and reduce missed diagnoses.