Death rates from chronic lung disease ‘radically reduced’ with 24/7 specialist respiratory care
Work at The Northumbria hospital in Cramlington is proving that direct admission under respiratory specialist care 24/7 can radically reduce death rates from chronic lung disease, according to new research presented at the British Thoracic Society Winter Meeting today (Friday 8th December 2017).
The research showed a substantial fall in death rates of patients admitted with an acute deterioration of chronic obstructive pulmonary disease (COPD), both in hospital and 30 days after discharge. Combining both periods, mortality fell from 18.1% to 10.4% for those who required ventilation, and from 6.2% to 4.3% for those who did not.
The study was carried out in response to the NCEPOD ‘Inspiring Change’ report published in 2015 which showed unacceptably high in-hospital death rates (25.1%) for COPD patients who had an acute deterioration of their disease requiring ventilation.
In June 2015 Northumbria Specialist Emergency Care Hospital (NSECH) was launched with all the following key features:
- Direct transfer from emergency department to speciality wards
- Seven day consultant review
- Respiratory Support Unit for non-invasive ventilation (NIV) (airway support administered through a face mask) with enhanced staffing ratios (1-2 care staff per patient), with trained physiotherapists setting up all NIV, monitoring and weaning off – one point of call
- 24/7 speciality consultant on-call
Northumbria Healthcare NHS Foundation Trust has the largest geographical footprint in the UK and a high number of patients with COPD, and so the number of hospital admissions with COPD over the study period was substantial.
The new research analysed 6,291 COPD patients from 1 January 2013 to 31 December 2016 with comparisons made between those pre- and post- the launch of the new hospital. A thorough analysis of the population characteristics showed similar demographic and clinical features. Ventilation status of the patients was verified.
The study also identified a number of other key benefits to this new approach:
- Over 97% of patients who required NIV were admitted under a respiratory physician
- Length of stay in hospital reduced, from 9 to 8 days for ventilated patients and from 4 to 3 days for patients not requiring ventilation.
Dr. Nicholas Lane, member of the British Thoracic Society, and NIV Outcomes Research Fellow at Northumbria Healthcare NHS Foundation Trust said:
“This was not an overnight switch – these changes have taken place over time as we audit, re-audit and evaluate, but we can see them making a great difference.
The main change has been providing access to a consultant specialist early in every hospital admission, rather than seeing a general consultant first. But we have also invested strongly in technical and workforce respiratory support – with enhanced staffing and additional ventilators to ensure we always have capacity to offer this life saving treatment to patients who need it.
For patients to have access to the specialist care they need 24 hours, seven days a week, is a huge step forward. It is genuinely saving lives.”
Dr Stephen Bourke, COPD and NIV clinical and research lead at Northumbria Healthcare NHS Foundation Trust, highlighted: “The COPD and NIV outcomes also reflect the dedication of the respiratory nursing and physiotherapy teams, with sustained quality improvement initiatives.
Reduced mortality following the opening of NSECH built upon already excellent outcomes. For ventilated patients, in-hospital mortality was 13.1% and fell to 9.2% post NSECH, compared to 25.1% in the NCEPOD report.
The key elements of this service closely map to the British Thoracic Society NIV Quality Standards (expected to be published in 2018); wider adoption of these standards across the NHS will save lives, and while moving to a full specialist emergency care model will present greater challenges to NHS Trusts, it should lead to a further improvement in survival.”
Chronic obstructive pulmonary disease (COPD) is the name for a group of lung diseases that narrow the airways causing breathing difficulties. COPD inflicts a huge toll on patients, their carers, and on the NHS. In total, 1.2 million people in the UK have been diagnosed with COPD. There are 30,000 deaths from the disease in the UK each year.