Introduction Home mechanical ventilation (HMV) for patients with chronic respiratory failure is a growing therapeutic modality that can reduce morbidity and mortality.¹ HMV may be complex to establish and requires a clear care pathway from acute to community services. The aim was to ascertain factors influencing in-patient length of stay (LoS) and mortality in individuals requiring HMV who were unable to use the device independently.

All HMV was initiated in a respiratory high dependency unit (RHDU) in a university hospital.

Method A retrospective analysis of medical notes was conducted for all patients initiated on HMV between September 2012 and September 2013. Patients who were unable to manage the device independently were identified. Data collected included: admission data, social history, primary diagnosis, date deemed medically fit, readmission to RHDU, bed days post medically fit (section 5), reasons for delayed discharge and outcome.

LoS and bed day cost were calculated based on trust finance data for level 1 and 2 beds.

Results Twelve patients were identified and separated into 2 groups according to LoS: less than 5 days (group 1; n = 5) or greater than 5 days (group 2; n = 7).

Various primary diagnoses were represented in each group. The main variable separating groups was pre-admission social status. Patients with a live-in carer, willing spouse or established 24-hour care were discharged back to their original home within 4 days of being declared medically fit. Those without such care had an average LoS of 27.4 days (17–51), with a large increase in associated cost and mortality. (Table 1). All patients in Group 1 survived and were successfully discharged. The in-hospital mortality for patients in Group 2 was 86%.

Discussion HMV is a complex modality requiring specialist training to facilitate home use. Patients unable to manage HMV independently have significant care needs. This study showed that patients who do not have an established care network pre-discharge have an increased LoS and higher mortality. The current Continuing Healthcare process and Social Services structure is not robust enough to meet these patients’ needs.

References

1. European Respiratory Journal. 2005;25(6):1025-1031

2. Rello J, et al. Chest. 2010;137(5):1138-1144