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).
| Referrals | Pre-RPF (n=55) | Post-RPF (n=62) | Post-RPF by RPF (n=25) | Post-RPF no RPF (n=37) |
| Age, years | 64.9 (12.4) | 63.4 (12.0) | 62.8 (12.9) | 63.7 (11.6) |
| Gender, male | 21 (38.2) | 25 (40.3) | 9 (36.0) | 16 (43.2) |
| COPD | 26 (47.3) | 21 (33.9) | 5 (20.0) | 16 (43.2) |
| OHS | 12 (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).
- Copyright ©the authors 2016
