LAUSR

Introduction and Objectives Hypercapnic ventilatory failure is common and patients often present to hospital with decompensation. As well as requiring acute non-invasive ventilation (NIV), patients may require domiciliary NIV (D-NIV). Traditionally, inpatients requiring D-NIV awaited transfer to a hospital with a D-NIV service. Long wait times for transfer could result in; repeated decompensations, D-NIV services appearing inaccessible and alternative sub-optimal treatment options being considered. Increasing healthcare pressures mean newer models of care need to be considered to avoid delayed treatment. In May 2014 our D-NIV service implemented an outreach function. Inpatients referred for D-NIV were either visited at their base hospital, or attended as a day-case at our centre. Patients were assessed and, if appropriate, commenced on D-NIV. This study assessed the impact of our outreach service on accessibility to D-NIV services, hospital length of stay (LoS) and 90 day readmission rates (90R). Methods Data were collected retrospectively pre-outreach and prospectively post-outreach service. Diagnosis, LoS and 90R were collected for all patients referred for D-NIV from five referring hospitals between January 2008 and April 2017. Historic patient databases of patients receiving acute NIV at site A were searched to compare pre-outreach to post-outreach service D-NIV referral rates. Based upon current evidence based practice, case note review of the historic database was undertaken to identify patients eligible for consideration of D-NIV, but who were not referred. Results Table 1. Demonstrates the impact of the outreach service. The study demonstrates a significant increase in referral rates following implementation of the outreach service. A clinically important reduction (21 days) in average LoS and subsequent decrease in bed day costs was observed. The average LoS cost per patient requiring D-NIV establishment pre-outreach was £19,600, compared to £11 200 post-outreach service. A non-significant increase in 90R was observed. Conclusion An outreach service appears to improve referral rates for D-NIV. There was a trend towards reduced LoS, potentially saving £8400 per patient. Factors contributing to increased 90R warrant further investigation. Our D-NIV outreach service appears to be an effective model of care, which has significantly increased patient accessibility to D-NIV and could be easily implemented in other services. Abstract S39 Table 1 Referral rates, hospital LoS and 90 day readmission rates pre and post D-NIV outreach service Pre-outreach service Post-outreach service p-value Patients eligible for D-NIV Referral rates per acute NIV episodes at one referring site (Site A) (%) 10/669 (1.5%) 31/350 (8.9%) p<0.001 Further patients eligible for consideration of D-NIV at Site A but not referred (%) COPD COPD/OSA OHS NMD CWD 84/659 (9.8%) 58.3%(49) 4.7% (4) 30.9% (26) 1.1% (1) 4.7% (4) 1/319 (0.3%) 100% (n1) p<0.001 Patients at site A-E referred to D-NIV service (n) Diagnosis%(n): COPD COPD/OSA NMD OHS CWD Other Inpatient referral n=11 Outpatient referral n=7 Total n=17 38.9% (7) 0% (0) 16.7% (3) 38.9% (7) 5.6% (1) 0% (0) Inpatient referral n=68 26.4% (18) 10.2% (7) 7.4% (5) 47% (32) 5.9% (4) 2.9% (2) p=0.431 Patients referred to the service Pre-outreach service Site A-E Post-outreach service Sites A-E Hospital length of stay (days) Mean (SD) n=11 49(49) n=68 28(26) Mean diff 20.7 (95%CI −14 to 56) p=0.167 90 day readmission rate 90R 10% 30% p=0.264 COPD=chronic obstructive pulmonary disease, OSA=obstructive sleep apnoea, NMD=neuromuscular disease, OHS=obesity hypoventilation syndrome CWD=chest wall deformity.