Maintaining quality

There are comprehensive evidence-based clinical guidelines and quality standards for nearly all aspects of respiratory medicine in the UK, produced by NICE or the British Thoracic Society. Every guideline and quality standard has been developed in conjunction with patients and/or carers. All respiratory teams participate in regular national audits and other quality improvement projects such as care bundles. Respiratory physicians have also contributed to the production of epidemiological data.

Guidelines and quality standards : Respiratory physicians work through NICE, SIGN and their professional society, the British Thoracic Society (BTS), to produce comprehensive up-to-date clinical guidelines and quality standards. The BTS’s guideline process was accredited by NICE in 2011 and the respiratory guidelines are available to download from the BTS website. In order to provide a concise set of markers of good practice, quality standards are being produced for each BTS guideline. Respiratory physicians have also helped produce NICE guidance on stopping smoking, COPD, asthma, cystic fibrosis, idiopathic pulmonary fibrosis, pneumonia, tuberculosis and obstructive sleep apnoea. Respiratory physicians also worked closely with NHS England on the outcomes strategy for COPD and asthma. Respiratory physicians have supported the introduction and evaluation of care bundles.

National audits: The British Thoracic Society undertakes regular national audits of care. Different areas of practice are audited in a cyclical fashion. Areas covered recently include:

  • the national emergency oxygen audit
  • the national smoking cessation audit
  • the national bronchiectasis audit
  • the national community acquired pneumonia audit
  • the national non-invasive ventilation audit
  • the national asthma audit.

Respiratory physicians participated in the European Respiratory Society COPD audit and are leading the National Asthma and COPD Audit Programme (NACAP), which is a collaboration led by the Royal College of Physicians (RCP), working closely with a broad range of organisations including Asthma UK, the British Thoracic Society, British Lung Foundation, Primary Care Respiratory Society UK, Royal College of General Practitioners and the Royal College of Paediatrics and Child Health.

Epidemiological data: Data on epidemiological aspects of respiratory care are provided by INHALE, the Interactive Atlas of Lung Conditions in England and the NHS Atlas of variation. The BTS Lung Disease Registry Programme provides a means of national data collection for idiopathic pulmonary fibrosis (IPF) and sarcoidosis.

Accessing data for quality improvement

Respiratory physicians are actively involved in quality improvement, supported by an active standards and quality improvement programme developed and managed by the British Thoracic Society (BTS).

National data on common respiratory diseases were formerly available through the INHALE project and the Right Care Atlas of Healthcare Variation but are now collected on the NHS Digital website (formerly the Health and Social Care Information Centre HSCIC). Data on occupational lung diseases can be obtained from the Health and Safety Executive and  SWORD  (surveillance of work-related and occupational respiratory disease). 

Quality and Outcomes Framework data provides detailed information on NHS performance including respiratory disease areas, and BTS runs a nationally recognised programme of  respiratory audits. Standards for these audits are drawn from the range of  guidelines and quality standards  produced by the Society. BTS guidelines are accredited by NICE. These are linked to national guidelines (the Society is accredited by NICE). The audit programme is available via an online system that provides BTS members and others with the tools to audit, benchmark and identify areas for improvement in local services. A number of other national audits are available in respiratory medicine, for example the National Lung Cancer Audit  run by the RCP,  LUCADA  (lung cancer data), the National Asthma and COPD Audit and the National Review of Asthma Deaths (2012/13).

BTS has developed an Interstitial Lung Disease Registry covering idiopathic pulmonary fibrosis (IPF) and sarcoidosis. BTS and the RCP have established an accreditation scheme for pulmonary rehabilitation (PR), using BTS quality standards for PR as the baseline for the accreditation standard.