4. Improving recognition, improving practice
There is increasing evidence that, in cases of septicaemia, the death rate for otherwise fit young adults is higher than for younger children. The more positive outcome in children may be due to a combination of clinical management, postgraduate training, and higher referral rates of critically ill children to specialist paediatric centres.
Meningitis management in adults audit study
In 2001, the Chief Medical Officer commissioned an audit of the hospital care of adults with meningococcal disease. Researchers from the University of Bristol and the Health Protection Agency, along with clinical and public health experts, assessed clinical practice in England and Wales and evaluated the quality of care, in order to identify strategies to improve outcome.
Most adults with bacterial meningitis and meningococcal septicaemia present to junior doctors with limited experience of these conditions. Yet early recognition, assessment of disease severity, and institution of specific therapy are crucial.
The audit found that compliance with standards based on those of the British Infection Society was not widely achieved in a number of key areas including prompt assessment and initiation of treatment, adequate disease severity assessment and timely prevention of secondary cases.
The absence of a consistent approach to the management of meningitis was reflected in the considerable variation in quality of care between hospitals in relation to ‘best practice’.
The report recommended:
- Clinical records should clearly and accurately document all information essential to management, including assessment of disease severity, which should be incorporated into a standard generic medical clerking proforma.
- On presentation to hospital, patients with suspected bacterial meningitis and meningococcal septicaemia should have a comprehensive clinical assessment as a matter of urgency.
- Normally all patients should be assessed, commence resuscitation and antibiotic therapy within one hour of presentation.
- Patients should be reviewed by a senior member of the clinical team, where appropriate as a matter of urgency.
- Competency standards developed to assess the training of junior doctors should be assessed for their applicability to the management of severe infections.
- Consensus guidelines on management of these conditions should be promoted using interventions that effectively improve compliance.
The audit was commissioned by Sir Liam Donaldson, Chief Medical Officer.
“Recognition of meningococcal disease is often difficult, particularly in adults,” says Sir Liam.
“Every year, a small number of cases are missed by clinicians. This study highlights the importance of early recognition, assessment of disease severity, and the introduction of specific therapy.
“I will be considering the recommendations made in this report to determine how we can further improve clinical management of adults with meningococcal disease.”
