P227 Non-invasive ventilation: improvements in patient selection, time to treatment, and escalation planning

Introduction Better patient selection for non-invasive ventilation (NIV), and time to NIV initiation, are national improvement objectives.1Treatment escalation planning (TEP) was also identified locally as a priority. Intervention Multiple quality improvement programmes were implemented in 2019 across two hospital sites within one NHS trust, including a move to 24-hour critical care outreach nursing; introduction of a TEP document to the clerking booklet; a redesigned user-friendly NIV proforma; a standardised respiratory discharge summary template; and presentation at local governance meetings. Measurement The BTS NIV audit toolkit was used to assess NIV care pre-intervention in February - March 2019, and post-intervention in February - March 2020, with inclusion criteria and methodology as specified elsewhere.2 Results Results are reported for 2020 compared to 2019. Fewer patients received NIV (21 vs 32), with proportionally more cases of COPD (16/21 [76%] vs 21/32 [66%]), and fewer cases of pneumonia (2/21 [10%]) vs 5/32 [16%]). More patients had NIV started within 1 hour of the last pre-NIV blood gas (15/17 [88%] vs 11/19 [58%]). More patients had a documented TEP (20/21 [95%]) vs 27/32 [84%]), and more of these were recorded pre-NIV (12/20 [60%] vs 14/27 [52%]). There was a statistically significant higher rate of patients involved in TEP decision making (17/20 [94%] vs 14/27 [52%], p=0.003), and more patients for whom NIV was the ceiling of care (18/20 [90%] vs 12/27 [54%], p=0.002). Discussion Introducing a TEP document to the clerking proforma, with a specific question regarding suitability for NIV, improved early patient-centred decision making about treatment escalation. Though numbers were small and not statistically significant, there was an overall reduction in NIV use, particularly for non-COPD patients, suggesting better patient selection, as well as improved time to NIV initiation. Reference British Thoracic Society. Adult NIV Audit Report ( 2019). British Thoracic Society. National Audit Protocol and Instructions ( 2019).