Beating Breathlessness: Implementation of the Adult Breathlessness Pathway by the Everton in the Community using Clinical Guided Consultation software (ID 603)
Liverpool University Hospitals NHS Foundation Trust
Abstract
Introduction:
The NHS England Adult Breathlessness Pathway facilitates a structured approach to the evaluation of breathlessness, a condition where a delayed or incorrect diagnosis may result in adverse patient outcomes. We report the feasibility of implementing clinical decision support system software to facilitate uptake of this pathway in the setting of a 1 stop-shop “Beat Breathlessness” hub at “Everton In the Community”, the official charity of Everton Football Club.
Methodology/Pathway development:
The clinical pathway is outlined in Figure 1. Patients >40 years old experiencing chronic persistent breathlessness are invited to attend a clinic where they undergo review by specialist nursing staff using the Cardio-LungHealth software (LungHealth Ltd) with medical oversight (general practitioner, consultant cardiologist & respiratory physician). Cardio-LungHealth is a clinical guided consultation intelligently integrating a structured history, physical examination with results from key investigations such as NT-Pro BNP, Spirometry, FeNO and HbA1c thus generating a final diagnosis or alerting the operator to the possibility a significant cardio-respiratory condition.
Results:
299 patients (mean age 61 (SD 18) years; 55% Female; mean BMI 27 (SD 5.30) 32% mMRC>=2) underwent review using the Cardio-LungHealth guided consultation from 16/4/24 to 19/3/25. Spirometry was performed in 61 patients who had no previous respiratory diagnosis. Of these, 38% (23/61) had spirometry consistent with COPD (3 categorised Gold Group E & 12 staged Gold Group B). 7 patients were found to have abnormally low peripheral oxygen saturations <=93%. 96 patients had point of care NT-Pro BNP levels checked and of these, 29 (30%) were elevated >400 ng/L including 5 patients >=2000png/L (all underwent AI echocardiography and specialist assessment). All these cases were flagged by the software prompting the user to trigger further investigation. The software prompted the user to administer smoking cessation support and offer community referral in all tobacco users.
Conclusion:
This evaluation demonstrates the feasibility of using clinical decision support software enabling the structured evaluation of breathlessness in line with guidance from the NHS England pathway. Further studies are required to determine suitability of this pathway as a scalable solution involving other healthcare staffing models e.g. healthcare assistants working under senior medical oversight.
Funding: The BEAT Breathlessness Project was funded by Astra Zeneca
Conflicts of interest: The Computer Guided Consultation (CGC) is owned by LungHealth Ltd. Drs. Chakrabarti, Angus, Davies, Professor Pearson and Mr McKnight are all directors of LungHealth Ltd. Mr McKnight is the Managing Director of National Services for Health Improvement Ltd. None of the LungHealth directors were involved in any of the patient reviews or project clinical oversight. Christopher Pritchard serves as the Primary Care Mental Health Lead for Cheshire & Merseyside ICB.
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