Enhancing Adherence to British Thoracic Society Guidelines for Follow-Up Chest Radiographs in Community-Acquired
Aabid Nehvi1, Susan Buckingham2, Moein Mobini2
1Emergency Medicine, East and North Hertfordshire Teaching NHS Trust, Stevenage, GBR.
Cureus
|September 24, 2025
Summary
A quality improvement project significantly increased follow-up chest X-rays (CXRs) for community-acquired pneumonia (CAP) patients from 32% to 70%. This initiative improved patient care and diagnostic timeliness by implementing education and enhanced electronic documentation.
Area of Science:
- Respiratory Medicine
- Quality Improvement Science
- Diagnostic Imaging
Background:
- Community-acquired pneumonia (CAP) is a prevalent respiratory infection in adults, contributing to significant morbidity and mortality.
- National guidelines advocate for follow-up chest radiographs (CXRs) for CAP patients with persistent symptoms or increased risk of malignancy.
- Inconsistent adherence to follow-up CXR protocols necessitates quality improvement initiatives to enhance patient care and reduce diagnostic delays.
Purpose of the Study:
- To evaluate and enhance adherence to guidelines for approximately six-week follow-up CXRs post-CAP using a two-cycle quality improvement project (QIP).
- Primary objective: Increase CXR completion rates from baseline (32%) towards the ≥90% audit standard.
- Secondary objectives: Boost Virtual Pneumonia Clinic (VPC) referrals and Critical Alert System (CAS) inclusions.
Main Methods:
- A retrospective, two-cycle audit of 100 adult CAP patients in a UK Emergency Department (ED).
- Intervention bundle included staff education, mandatory electronic discharge prompts, multilingual patient leaflets, and standardized electronic alerting.
- Outcomes measured: follow-up CXR completion, VPC referrals, and CAS inclusions, assessed before and after the intervention.
Main Results:
- Follow-up CXR completion increased significantly from 32% (16/50) in Cycle 1 to 70% (35/50) in Cycle 2 (p<0.001).
- VPC referrals rose from 24% to 76% (p<0.001), and CAS inclusions increased from 6% to 72% (p<0.001).
- No significant unintended effects like alert fatigue or increased workload were observed.
Conclusions:
- A low-cost, multi-component intervention significantly improved adherence to recommended follow-up CXRs after CAP.
- The intervention, integrating education, prompts, patient information, and robust alerting, proved feasible and scalable.
- Continued monitoring and optimization are crucial to achieve and sustain the target ≥90% compliance rate.
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