Non-invasive ventilation at the front door: a service improvement
Background: Commencing non-invasive ventilation (NIV) promptly at the front door is crucial in patients presenting with acute exacerbations of chronic obstructive pulmonary disease (COPD) complicated by acute hypercapnic respiratory failure.1 Studies show that it reduces mortality and shortens the l...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
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| Series: | Future Healthcare Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2514664525001973 |
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| Summary: | Background: Commencing non-invasive ventilation (NIV) promptly at the front door is crucial in patients presenting with acute exacerbations of chronic obstructive pulmonary disease (COPD) complicated by acute hypercapnic respiratory failure.1 Studies show that it reduces mortality and shortens the length of hospital stay.1,2National Guidelines from the British Thoracic Society (BTS) recommend a door-to-mask time of <2 h, and arterial blood gases (ABGs) at 1 and 4 h after initiation of NIV, to monitor the effectiveness of treatment.3 However, national data showed poor compliance with this guidance.4Our project aimed to assess the timely initiation of NIV, probe into the factors leading to any delays, and improve compliance through staff education. Methodology: We carried out a two-cycle quality improvement project. Retrospective data were obtained for a 6-month period (n=20), assessing factors contributing to any delays in NIV initiation, and if response to treatment using ABGs was monitored adequately. Since front-door clinicians make the bulk of decisions pertaining to NIV, we surveyed registrars in the emergency department and general medicine to find out how confident they felt about initiating, titrating and weaning off NIV. We also asked front-door clinicians about the challenges they encounter that lead to delays in timely initiation. In addition, we organised a series of hands-on practical NIV training sessions for registrars and consultants.Subsequently, we completed a second cycle (n=15) to see the results of our interventions. Results: Our results showed remarkable improvement: the proportion of patients commenced on NIV within 2 h increased from 25% to 54%. Education of front-door clinicians reduced the delay in decision-making from 42% in Cycle 1 to 25% in Cycle 2. Resource limitation remained a limiting factor contributing to half the delays. The proportion of patients being monitored with 1- and 4-h ABGs increased remarkably (33% to 83%, and 8% to 67%, respectively). Clinical outcomes remained favourable. Conclusion: Early recognition and timely initiation of NIV are vital to improving patients’ outcomes. However, medical registrars in other specialties do not receive any relevant training. Enhancing education and confidence with hands-on practical training of front-door clinicians is vital for service improvement and providing our patients with best possible care. |
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| ISSN: | 2514-6645 |