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

2. 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 2

3. The Health Roundtable 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 3

4. The Health Roundtable 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 NIVAnnual growth in patients implemented 4

5. The Health Roundtable 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 5

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

7. The Health Roundtable OUTCOMES Adverse events on waiting list (death or admission to hospital) June 05 – Nov 07Dec 07 – June 12 Numbers of patients PrePostP Value PaCO 2 48 mmHg44 mmHg0.46 Sleep Efficiency60 (6.5)48 (6.0)0.19 Arousal index10.8 (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

8. The Health Roundtable 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) 8

9. 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 9