The study, to assess practice in the care of adults with suspected community-acquired bacterial meningitis in the UK and Ireland and published in BMJ Open, concludes ‘there is considerable room for improvement.’
Covering 64 UK and Irish hospitals and 1,471 adults with community-acquired meningitis, the research found that none of the 2016 audit standards on diagnosis and management of meningitis were met in all cases.
With respect to 20 of 30 assessed standards, clinical management provided for patients was in line with recommendations in less than 50% of cases.
The 30 standards, which cover the immediate management of patients, investigations, treatment, critical care and notification, set times on, for example, how quickly a lumbar puncture should be performed and antibiotic treatment should commence.
Findings showed that only 45% of patients had blood cultures taken within an hour of admission, 0.5% had a lumbar puncture within one hour, and 26% within eight hours. Only 28% had bacterial molecular diagnostic tests on cerebrospinal fluid and average time to receiving a first dose of antibiotics was 3.2 hours, rather than the one hour that the standard states.
Hugely significant report
Dr Tom Nutt, our chief executive, said: “This is a hugely significant report and although it's disappointing to see the evidence that clinical care is falling short of evidence-based guidelines, it’s perhaps not entirely surprising.
‘However, knowing what is happening is half the battle to putting it right in the future. We hope that the findings will be incorporated in the new guideline on meningitis, currently being developed by the National Institute for Clinical Excellence. For the first time, this will include guidance for adult patients as well as children.
“After all, what we all want is the best possible diagnosis, care and treatment for those admitted to hospital with meningitis, where we know speed is of the essence if we are to achieve the best outcome. Knowing why the guidelines are not being followed and then creating a culture of continuous improvement by building on the findings in this study are good places to start to make the necessary improvements.”
Further research required
The study concludes: “We anticipate that a NICE guideline will improve awareness and uptake of good practice in the short term. In addition to education, which has limited impact on changing behaviour, UK hospitals should use quality improvement methods to improve management of patients with suspected meningitis.
“Good qualitative research to identify what the barriers to implementing the guidelines are should also be done. We suggest a national strategic improvement plan should focus on the following key areas: timely use of diagnostics; appropriate antibiotics in at risk populations and the use of adjunctive steroids.”
Further work should also be done once the guideline is published to ensure it translates into changed practice.
Read more: Clinical management of community-acquired meningitis in adults in the UK and Ireland in 2017: a retrospective cohort study on behalf of the National Infection Trainees Collaborative for Audit and Research (NITCAR) | BMJ Open