PT - JOURNAL ARTICLE AU - Andrew Taylor AU - Sanaa Ismail AU - Darshan Pandit AU - Adam Seccombe TI - Door to NIV time: A tale of three audits over 4 years - Are we getting better? DP - 2013 Sep 01 TA - European Respiratory Journal PG - P4759 VI - 42 IP - Suppl 57 4099 - http://erj.ersjournals.com/content/42/Suppl_57/P4759.short 4100 - http://erj.ersjournals.com/content/42/Suppl_57/P4759.full SO - Eur Respir J2013 Sep 01; 42 AB - BackgroundProlonged type 2 respiratory failure (T2RF) is associated with increased mortality thus delay in starting non-invasive ventilation (NIV) treatment should be minimised. BTS guidelines recommend up to one hour of best medical therapy before considering NIV.Aims and ObjectivesRetrospective audits in 2008 and 2010 at a UK city hospital found delays in NIV initiation. This prompted a proforma for NIV candidates in 2008 and junior doctor training to ensure best medical therapy prior to NIV in 2010. A 2012 audit aimed to investigate the impact of these measures.MethodsAll patients receiving NIV for T2RF from August to October 2012 were reviewed prospectively. Those receiving CPAP or who used home NIV were excluded as per previous audits. Data from the notes were used to calculate time delays along the NIV pathway and gather clinical and demographic variables.ResultsThe average time from door to NIV in 2008 was 325 minutes. This improved to 287 minutes in 2010 following the introduction of a proforma. In 2012 this time increased to 340 minutes. Further analysis showed that this increase was in large part due to a reduction in the percentage of patients receiving NIV less than one hour from admission (31.4% in 2010; 10.3% in 2012) suggesting a sufficient trial of maximum medical therapy had been attempted in more cases. Mortality was reduced from 46.7% in 2010 to 24.5% in 2012 with no significant change in the patient characteristics.ConclusionsThe use of a proforma alongside focused training has led to more appropriate NIV use. Our audit highlights the importance of using NIV alongside, not instead of, best medical therapy; the observed fall in mortality a good reflection of improved practices.