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Inpatient transfer for commencement of home NIV: Does a proforma improve practice?

Karen Ward, Helen Ashcroft, Verity Ford, Sara Wordingham-Baker, Robert Angus, Biswajit Chakrabarti, Nick Duffy, Robert Parker
European Respiratory Journal 2016 48: PA3059; DOI: 10.1183/13993003.congress-2016.PA3059
Karen Ward
1Liverpool Sleep and Ventilation Service, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Helen Ashcroft
1Liverpool Sleep and Ventilation Service, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Verity Ford
1Liverpool Sleep and Ventilation Service, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Sara Wordingham-Baker
1Liverpool Sleep and Ventilation Service, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Robert Angus
1Liverpool Sleep and Ventilation Service, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Biswajit Chakrabarti
1Liverpool Sleep and Ventilation Service, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Nick Duffy
1Liverpool Sleep and Ventilation Service, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Robert Parker
1Liverpool Sleep and Ventilation Service, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom
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Abstract

Background: Little guidance exists on patient selection for home non-invasive ventilation (NIV) after acute NIV. The role of home NIV in pure COPD is inconclusive (Struik et al. Thorax 2014).

Aims: Evaluation of the effect of a referral proforma (RPF) on patient characteristics and outcomes.

Methods: The RPF was developed based on current evidence. Data collection pre- and post-RPF included diagnosis, length of stay and survival (Oct '12–Feb '15).

Results: Pre-RPF, 55 referrals were received (3.7/month); 8 transfers were not given NIV. Post-RPF, 62 referrals were received (4.8/month), of whom only 25 (40.3%) were referred by RPF. All post-RPF transfers were given NIV; 2 declined.

Gender and age varied little (Table One). No significant difference in length of stay, 6- and 12-month survival was seen (pre-RPF v. post-RPF; and pre-RPF v. post-RPF by RPF only).

Fewer COPD patients were referred post-RPF (33.9% v. 47.3%, p=0.14). Those referred by RPF were significantly less likely to have COPD than pre-RPF (20.0% v. 47.3%, p=0.02), with increased OHS (obesity hypoventilation; 35.1% v. 21.8%, p=0.04). Referrals without RPF showed similar COPD rates to pre-RPF (47.3% v. 43.2%, p=0.71).

ReferralsPre-RPF (n=55)Post-RPF (n=62)Post-RPF by RPF (n=25)Post-RPF no RPF (n=37)
Age, years64.9 (12.4)63.4 (12.0)62.8 (12.9)63.7 (11.6)
Gender, male21 (38.2)25 (40.3)9 (36.0)16 (43.2)
COPD26 (47.3)21 (33.9)5 (20.0)16 (43.2)
OHS12 (21.8)24 (38.7)11 (44.0)13 (35.1)
  • Data are number (%) or mean (SD); RPF = referral proforma

NIV Referrals

Conclusion: While home NIV in COPD is debated, an RPF may improve practice while highlighting the challenges of changing existing behaviours (Stoller, Respiratory Care 2010).

  • Non-invasive ventilation - long-term
  • COPD - management
  • Health policy
  • Copyright ©the authors 2016
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Inpatient transfer for commencement of home NIV: Does a proforma improve practice?
Karen Ward, Helen Ashcroft, Verity Ford, Sara Wordingham-Baker, Robert Angus, Biswajit Chakrabarti, Nick Duffy, Robert Parker
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3059; DOI: 10.1183/13993003.congress-2016.PA3059

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Inpatient transfer for commencement of home NIV: Does a proforma improve practice?
Karen Ward, Helen Ashcroft, Verity Ford, Sara Wordingham-Baker, Robert Angus, Biswajit Chakrabarti, Nick Duffy, Robert Parker
European Respiratory Journal Sep 2016, 48 (suppl 60) PA3059; DOI: 10.1183/13993003.congress-2016.PA3059
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