TY  - BOOK
AU  - Jose, R.
AU  - Moonsie, I
TI  - An outreach service for domiciliary noninvasive ventilation (NIV) improves access for patients
PY  - 2017///
N1  - NMUH Staff Publications; 72
N2  - <span style="font-size: 10pt;"><span style="color: #4a4a4a; font-family: Lato, "Helvetica Neue", Helvetica, Arial, sans-serif; text-decoration-color: initial;">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 DNIV, 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. [Conference abstract]</span></span&gt
UR  - http://thorax.bmj.com/content/72/Suppl_3/A27
ER  -