Introduction Acute non-invasive ventilation (aNIV) is a well evidenced treatment for acute hypercapnic respiratory failure (AHRF) in COPD and other conditions including obesity hypoventilation syndrome, restrictive chest wall conditions and neuromuscular diseases. Within our service we recognised similar challenges and outcomes highlighted by NCEPOD’s ‘Inspiring Change’ document. In response to this and utilising BTS Quality Standards, we undertook a quality improvement project (QIP), introducing a multidisciplinary aNIV team including the skills of Clinical Scientists, Physiologists, Physiotherapists and Nurses. We present results from our first dataset.
Methods This is a retrospective study of patients who commenced aNIV according to local policy at a large university teaching hospital over a 6-month period. Outcome variables were based on BTS Quality Standards and reviewed using NCEPOD audit toolkit. In addition, physiology data, inpatient mortality, 30-day mortality and readmission rates were recorded.
Results Our patient cohort (47) was predominantly COPD patients (79%) with a mean pH of 7.25 (NCEPOD cohort; COPD 69%, pH 7.25). Mean referral to mask time was 22 minutes, with 80% seen and treated by aNIV team within 1 hour (30% prior to aNIV team). In total 30% of patients had a pre-NIV pH <7.25 and 16% <7.15. ABG sampling at 1 hr of NIV was completed in 97%. A total of 85% had an improved pH and 87% pC02 at 1 hr of NIV (range .01-.26; .16–6.29kpa, respectively) with complete reversal of respiratory acidosis in 17% of patients. In-patient mortality was lower than NCEPOD cohort and our previous audit (16%; 35%; 28%, respectively), 30-day mortality was 0% with a 14% 30-day re-admission rate. Assessment against BTS Quality Standards are shown in Table 1.
Discussion Our data shows that an aNIV MDT utilising NCEPOD toolkit is able to deliver BTS quality standards to a large percentage of patients and contribute towards a reduction in inpatient mortality. A well-defined aNIV pathway, dedicated on-call rota, specific proforma and robust staff competency framework contribute towards achieving these outcomes. Future research is required in order to fully understand the mechanisms by which further improvements in patient outcomes can be achieved.
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