NICE Suggests Out of Hospital Treatment this Winter for Acute Respiratory Infections

More people could be treated out of hospital in the NHS’s new respiratory hubs and virtual wards following new NICE draft guidance on the initial assessment and management of suspected acute respiratory infections (ARIs) published earlier this month.

The draft guideline covers diagnosing and managing suspected ARIs, including pneumonia, respiratory viruses, and flu in adults. It does not cover people with COVID-19. It aims to improve initial assessments and access to face-to-face appointments as well as the management of conditions to help reduce hospital admissions.

Acute respiratory infections have increased since the COVID pandemic and around 220,000 people are diagnosed with pneumonia in England and Wales every year. They are more common in winter and place a significant pressure on local healthcare resources.

For the first time NICE’s updated guidance includes recommendations to refer people to acute respiratory infection (ARI) hubs or acute respiratory infection virtual wards. It follows NICE recently publishing draft guidance recommending the use of virtual wards to monitor ARI patients aged 16 or over at home using digital technologies.

The updated guidance now says that if during an online consultation a person is suspected to have pneumonia, or if an adequate assessment cannot be made remotely, the person should be referred for a face-to-face assessment.

During the in-person appointment a clinical assessment will be carried out using what is known as the ‘CRB65 score’, which uses several factors including the person’s age, blood pressure and respiratory rate to help the clinician make a judgement about managing the person’s pneumonia.

The system helps to determine the risk to the patient and whether care can be safely managed at home, the new option of care at home through a virtual ward, or if in-hospital assessment and treatment is needed. It ensures that severely ill people are seen in hospital and avoids admission for those who do not need it, which is better for patients and the NHS during busy winter periods.

For people with symptoms of an ARI who present in-person at NHS services, including GP practices and walk-in centres, the guidance recommends not offering microbiological or influenza tests to determine whether to prescribe antibiotics, but instead to use a clinical assessment.

It also recommends clinicians consider a C-reactive protein (CRP) test – that can indicate the presence of infection – to help them decide whether to prescribe antibiotics to people without suspected pneumonia.

Professor Jonathan Benger, Director of Centre for Guidelines at NICE, said:

“This useful and useable guidance focuses on what matters most and will help ensure busy healthcare professionals provide the right care, at the right time depending on the individual needs of their patients.

“It will also help to support the additional capacity the NHS has created this winter and provide a richer urgent care pathway that meets the different needs of local populations.”

Professor Sir Stephen Powis, NHS national medical director, said: “Acute respiratory infections are one of the most common reasons why patients seek a GP appointment or attend hospital as an emergency. I am grateful to NICE for working with us on this new draft guidance which will help inform decisions on where a patient would be best treated while expanding the types of tests and other investigations used to determine the most appropriate treatment, which will be a real game-changer in the way we can deliver care for patients in the community.

“This guidance will be hugely welcomed by local NHS teams, enhancing their ability to deliver the best possible care for patients, including in our innovative acute respiratory infection hubs and virtual wards – improving access to face-to-face appointments and helping prevent unnecessary hospital admissions for patients.”