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Transcript of Austin
The Health Roundtable
Introduction of a day admission model for implementation of non-invasive ventilation
Presenter: Linda Rautela
Austin
Innovation Poster SessionHRT1215 – Innovation AwardsSydney 11th and 12th Oct 2012
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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
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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
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The Health Roundtable
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Avera
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ait
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ays)
Weekend service commenced
VRSS moves from Bowen Centre to Austin Tower
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 NIV Annual growth in patients implemented
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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
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The Health Roundtable
OUTCOMES
Average wait time for admission & implementation of NIV
Pre Post Day Admission Model
P= 0.02
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The Health Roundtable
OUTCOMES
Adverse events on waiting list (death or admission to hospital)June 05 – Nov 07 Dec 07 – June 12
Pre Post P Value
PaCO2 48 mmHg 44 mmHg 0.46
Sleep Efficiency 60 (6.5) 48 (6.0) 0.19
Arousal index 10.8 (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
The Health Roundtable
LESSONS LEARNTWith 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)
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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
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