Quality of in-hospital care for adults with acute bacterial meningitis: a national retrospective survey
From the 1Department of Cellular & Molecular Medicine, University of Bristol, Bristol, 2Bristol Health Protection Agency Laboratory, Bristol, 3Health Protection Agency South West, Stonehouse, 4Brighton & Sussex Medical School, Brighton, 5Department of Medicine, Royal Free and University College Medical School, London, 6Health Protection Agency, Colindale, London, 7Department of Paediatrics, St Mary's Hospital, London, 8Department of Public Health NHS, Forth Valley NHS Board, Stirling, and 9West Midlands Deanery & George Eliot Hospital, Nuneaton, UK
Address correspondence to Dr A. Gjini, Social Medicine Department, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, BS8 2PR, UK. email: ardiana.gjini{at}nhs.net
Received 20 June 2006 and in revised form 20 September 2006
Background: Most adults with bacterial meningitis and meningococcal septicaemia present to junior doctors who have limited experience of these conditions. In contrast to paediatric practice, data from industrialized countries with regard to current hospital management practice are lacking.
Aim: To examine whether current practice meets recommended standards in hospital management of community-acquired bacterial meningitis and meningococcal septicaemia among adults.
Design: National audit of medical records.
Methods: We conducted a survey of all patients with acute bacterial meningitis and meningococcal septicaemia admitted to 18 randomly selected acute hospitals in England and Wales between 1 January 2000 and 31 December 2001. All stages of care, including pre-hospital management, initial hospital assessment, record keeping, and ongoing hospital and public health management, were assessed.
Results: We identified 212 cases of bacterial meningitis and meningococcal septicaemia; 190 cases remained in the final analysis. Clinical record keeping did not meet acceptable standards in 33% of cases. Parenteral antibiotics were given within 1 h of hospital arrival in 56% of cases, increasing to 79% among those with an initial differential diagnosis that included bacterial meningitis or meningococcal septicaemia. A full severity of illness assessment was made in 27%. The quality of clinical practice varied widely between hospitals. This was most pronounced in the timeliness of consultant review (p < 0.0005).
Discussion: The quality of adult clinical practice for bacterial meningitis and meningococcal septicaemia needs improvement. This study provides a tool for developing targeted interventions to improve quality of care and outcome among adults with life-threatening infections, both in the UK and in other countries.