Austin

1. Innovation Poster Session HRT1215 – Innovation Awards Sydney 11th and 12th Oct 2012 Introduction of a day admission model for implementation of non-invasive ventilationPresenter: Linda Rautela Austin

2. 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

3. 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

4. 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

5. 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

6. OUTCOMES P= 0.02 Pre Post Day Admission Model Average wait time for admission & implementation of NIV

7. OUTCOMES • 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 Numbers of patients June 05 – Nov 07 Dec 07 – June 12 Adverse events on waiting list (death or admission to hospital) Effectiveness of Ventilation

8. LESSONS LEARNT With 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)

9. 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