S39 An outreach service for domiciliary non-invasive ventilation (niv) improves access for patients. (15th November 2017)

• Record Type: Journal Article
• Authors: Mansell, SK; Cutts, S; Kanakaraj, R; Jose, R; Mackay, A; Moonsie, I; Mandal, S
• Is Part Of: Thorax. Volume 72(2017)Supplement 3
• Page Start: A27
• Page End: A27
• Publication Date: 2017-11-15
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2017-210983.45
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction and Objectives: Hypercapnic ventilatory failure is common and patients often present to hospital with decompensation. As well as requiring acute non-invasive ventilation (NIV), patients may require domiciliary NIV (D-NIV). Traditionally, inpatients requiring D-NIV awaited transfer to a hospital with a D-NIV service. Long wait times for transfer could result in; repeated decompensations, D-NIV services appearing inaccessible and alternative sub-optimal treatment options being considered. Increasing healthcare pressures mean newer models of care need to be considered to avoid delayed treatment. In May 2014 our D-NIV service implemented an outreach function. Inpatients referred for D-NIV were either visited at their base hospital, or attended as a day-case at our centre. Patients were assessed and, if appropriate, commenced on D-NIV. This study assessed the impact of our outreach service on accessibility to D-NIV services, hospital length of stay (LoS) and 90 day readmission rates (90R). Methods: Data were collected retrospectively pre-outreach and prospectively post-outreach service. Diagnosis, LoS and 90R were collected for all patients referred for D-NIV from five referring hospitals between January 2008 and April 2017. Historic patient databases of patients receiving acute NIV at site A were searched to compare pre-outreach to post-outreach service D-NIV referral rates. Based upon current evidence based practice, case note review of the historic database was undertaken to identify patients eligible for consideration of D-NIV, but who were not referred. Results: Table 1 . Demonstrates the impact of the outreach service. The study demonstrates a significant increase in referral rates following implementation of the outreach service. A clinically important reduction (21 days) in average LoS and subsequent decrease in bed day costs was observed. The average LoS cost per patient requiring D-NIV establishment pre-outreach was £19, 600, compared to £11 200 post-outreach service. A non-significant increase in 90R was observed. Conclusion: An outreach service appears to improve referral rates for D-NIV. There was a trend towards reduced LoS, potentially saving £8400 per patient. Factors contributing to increased 90R warrant further investigation. Our D-NIV outreach service appears to be an effective model of care, which has significantly increased patient accessibility to D-NIV and could be easily implemented in other services.