A new specialist emergency care hospital in Northumbria has found that direct admission under respiratory specialist care 24/7 can radically reduce death rates from chronic lung disease.
The improved outcomes also reflected the “dedication” of the hospital’s respiratory nursing teams, which achieved sustained quality improvement, said researchers.
“These changes have taken place over time as we audit, re-audit and evaluate, but we can see them making a great difference”
Their study showed a substantial fall in death rates of patients admitted with an acute deterioration of chronic obstructive pulmonary disease, both in hospital and 30 days after discharge.
Combining both periods, mortality fell from 18.1% to 10.4% for those who required ventilation, and from 6.2% to 4.3% for those who did not, according to researchers.
The study was carried out in response to a report published in 2015 by the National Confidential Enquiry into Patient Outcome and Death – titled Inspiring Change. It had identified in-hospital death rates of 25.1% for COPD patients who had an acute deterioration of their disease requiring ventilation.
In June 2015, the Northumbria Specialist Emergency Care Hospital (NSECH) was launched by Northumbria Healthcare NHS Foundation Trust.
“The COPD and NIV outcomes also reflect the dedication of the respiratory nursing and physiotherapy teams”
It has features including direct transfer from emergency department to speciality wards, seven-day consultant review, a respiratory support unit for non-invasive ventilation (NIV) with enhanced staffing ratios – one to two care staff per patient – and 24/7 speciality consultant on-call.
The trust has the largest geographical footprint in the UK and a high number of patients with COPD, and so the number of hospital admissions with COPD over the study period was substantial.
The study analysed 6,291 COPD patients from 1 January 2013 to 31 December 2016, with comparisons made between those pre- and post- the launch of the new hospital.
A thorough analysis of the population characteristics showed similar demographic and clinical features. Ventilation status of the patients was verified.
The study also identified a number of other key benefits. For example, length of hospital stay was reduced, from nine to eight days for ventilated patients and from four to three days for others.
- Over-diagnosis of COPD risks unnecessary scripts for inhalers
- Nurse-led team improving outcomes for pneumonia patients
Dr Nicholas Lane, NIV outcomes research fellow at Northumbria Healthcare, said: “This was not an overnight switch – these changes have taken place over time as we audit, re-audit and evaluate, but we can see them making a great difference.
He said: The main change has been providing access to a consultant specialist early in every hospital admission, rather than seeing a general consultant first. But we have also invested strongly in technical and workforce respiratory support – with enhanced staffing and additional ventilators to ensure we always have capacity to offer this life saving treatment to patients who need it.
“For patients to have access to the specialist care they need 24 hours, seven days a week, is a huge step forward,” he said. “It is genuinely saving lives.”
Dr Stephen Bourke, COPD and NIV clinical and research lead at the trust, added: “The COPD and NIV outcomes also reflect the dedication of the respiratory nursing and physiotherapy teams, with sustained quality improvement initiatives.”
He said the key elements of the new service were set to “closely map” future British Thoracic Society NIV Quality Standards, which are expected to be published in 2018.
“Wider adoption of these standards across the NHS will save lives, and while moving to a full specialist emergency care model will present greater challenges to NHS trusts, it should lead to a further improvement in survival,” he said.
The study findings were presented today at the British Thoracic Society’s 2017 Winter Meeting in London.
Northumbria Specialist Emergency Care Hospital