Publish date: 15 February 2021

Specialist hospital unit key to Covid fight

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Dedicated NHS units that specialise in providing urgent care for patients who need help breathing are proving a key tool in the battle against Covid, with clinical teams at Northumbria seeing the benefits first hand.

The innovative Respiratory Support Unit (RSU) at The Northumbria Specialist Emergency Care Hospital (NSECH) has been a huge part of the local response, with many patients coming into hospital severely ill but not yet requiring intensive care support.

The RSU enables patients to get enhanced breathing support and access to a wide range of specialist respiratory doctors, nurses and other healthcare professionals who have wide experience of treating these types of patients.

They work closely with their intensive care colleagues to get patients into ITU quickly if they do deteriorate, but also to get them out again as soon as possible meaning they get the highest quality care at the right time.

Last week the chair of the British Thoracic Society, Professor Jon Bennett praised the impact of RSUs during the pandemic and said they could help revolutionise acute respiratory care for patients.

Northumbria has had an RSU since 2015 and it has had a transformative impact on the services to patients, mortality rates and the ability to care for people with Covid.

This innovative approach includes:

  • A multidisciplinary team approach to looking after patients using the enhanced skills of nursing and physio staff.
  • Bringing all the relevant expertise to one place within the hospital.
  • Freeing up critical care capacity.
  • Providing a more flexible approach to looking after the most poorly patients.

Dr Mark Weatherhead, Head of Service for respiratory medicine at Northumbria Healthcare said:

“The North East historically has a high number of people with chronic obstructive pulmonary disease (COPD) and the unit was initially set up at NSECH with this in mind.

“It was established to take direct transfers from the emergency department, have 24/7 speciality consultants on-call, increased levels of support, the most senior doctors reviewing patients seven days a week and, crucially, the ability to provide non-invasive ventilation and CPAP.”

This type of breathing support administered through a face mask has been crucial when treating Covid19 and because physios were trained in setting up, monitoring and weaning off this type of ventilation it meant the unit was already ahead of the game when Covid hit.

Research done on the unit prior to the pandemic found that it helped reduce the length of stay in hospital from 9 to 8 days for ventilated patients and from 4 to 3 days for patients not requiring ventilation.

Professor Stephen Bourke, Consultant in respiratory medicine and Honorary Professor at Newcastle University said:

“The unit has been a core part of the NSECH respiratory model of care since it opened and we have published data showing improved survival and a shorter length of stay for both ventilated and non-ventilated COPD patients. The mortality in patients requiring ventilation is less than half the national average.

“In many other conditions acute NIV may offer better outcomes than invasive ventilation. Rather than a holding measure it can actually be superior because the patient is not sedated and paralysed, their airway defences are not compromised so ventilator associated pneumonia is less of an issue and other complications are avoided.”

“The work we had already done establishing conservative oxygen target saturations left us well placed for the Covid pandemic when it hit. The RSU has allowed us to take a lead role in providing ventilatory support for patients, including a large cohort who were not considered for escalation – with good survival rates on non-invasive respiratory support.

“Nurse to patient ratios are reviewed several times each day, while the physio team continue to take a lead role in providing CPAP and non-invasive ventilatory support.”

You can hear an audio interview on the Northumbria RSU by clicking here