The Health Roundtable

Introduction of a day admission model for implementation of non-invasive ventilation

Presenter: Linda Rautela

Austin

Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012

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The Health Roundtable

KEY PROBLEM: Unacceptable wait time for starting non-invasive ventilation (NIV) NIV is the application of mechanical ventilatory support via a face mask for 6-24

hours per day It is essential therapy for patients with chronic respiratory failure due to

weakness of the breathing muscles, abnormal chest wall mechanics and some forms of chronic lung disease

Without access to timely and effective NIV such patients have significant risk of worsening symptoms and overt respiratory failure, hospital admission and even death

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AIM OF THIS INNOVATION

To identify patients with signs of respiratory failure and ascribe an urgency category

To commence patients on NIV in a timely fashion according to clinical urgency

To reduce adverse events whilst on the waiting list

To offer single day admission as an alternative to multi day admission for implementation of NIV with no reduction in clinical outcomes or patient satisfaction

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Weekend service commenced

VRSS moves from Bowen Centre to Austin Tower

BASELINE DATA Increased pressure on inpatient hospital beds Prolonged waiting times to commencing NIV Adverse events whilst on the waiting list

Average wait time for admission & implementation of NIV Annual growth in patients implemented

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KEY CHANGES IMPLEMENTED

Change to a “Short Stay Admission Process”

Evaluation in clinics ascribes urgency category

Suitability for short admission determined

Consists of two short stay admissions

1. Day admission for implementation of NIV, allied health review

and formal education

2. Overnight admission and ventilation review

Outpatient clinic and outreach follow-up

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OUTCOMES

Average wait time for admission & implementation of NIV

Pre Post Day Admission Model

P= 0.02

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OUTCOMES

Adverse events on waiting list (death or admission to hospital)June 05 – Nov 07 Dec 07 – June 12

Pre Post P Value

PaCO2 48 mmHg 44 mmHg 0.46

Sleep Efficiency 60 (6.5) 48 (6.0) 0.19

Arousal index 10.8 (8.8) 12.8 (17.0) 0.79

Reduction in adverse events

No difference in the effectiveness of treatment: Short stay model as effective as previous model of care

Cost benefit: Average IP cost +

sleep study = $9200 Day Admission model

+ sleep study = $2200

Effectiveness of Ventilation 7

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LESSONS LEARNTWith careful patient assessment and selection a multi day admission for implementation of NIV can be reduced to a short stay process with the following benefits: Identification of early signs of respiratory failure and urgency category ascribed to commence NIV

Rapid initiation of NIV

Reduced hospital LOS

Decreased waiting time

Improved patient acceptance and control

No loss of clinical efficacy/detrimental effects

Improved process of patient education

Increased out patient follow up

◦ Allied health, phone calls

Areas requiring ongoing vigilance and improvement:Scheduling – patient and staff

Assessment of patients referred from other hospitals - particularly current inpatients

Staff communication processes to ensure appropriate follow up

Troubleshooting for patients in more remote locations

Model not suitable for all patients with VRSS admission waiting times remaining long for some:

◦ Physically disabled requiring carers

◦ Geographically isolated

◦ Delay of interhospital transfer (from ICU)

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The Health Roundtable

ACKNOWLEDGMENTS:

Dr Mark Howard - Director of VRSS Ian Batchelder Nicole Sheers Mel Holmes, Amanda McLaughlin, Judith Hamilton-Smith,

Taasha Chu VRSS Outreach Service David Berlowitz Staff of 5 West, Austin Health

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