Closing the gap in acute NIV: A scalable nurse-led approach to optimising time-critical care.

Abstract

Introduction The 2023 BTS RSU audit demonstrated a lower all-cause mortality for hospitals with an RSU and enhanced staffing ratios. At Sherwood Forest Hospitals (SHFT), an acute NIV nurse-led outreach and retrieval service, based on an RSU with enhanced staffing and central monitoring of observations, has been in place for over 8 years. However, data demonstrated our median gas and door-to-mask times were 03:29hrs, and 04:15hrs respectively, with delays noted in performing and interpretation of blood gases. Methods We created a digital tracker focusing on gas and door-to-mask times as our improvement measures. Following process mapping and root cause analysis, we redesigned our referrals process and developed an early assessment model for all acute patients. Acute NIV nurses perform an early clinical review at the initial identification of possible NIV patients, optimising patient care, ensuring timely blood gases and earlier ringfencing of RSU beds. Adopting and supplementing the BTS care bundle,2 we added 3 additional locally conceived standards to match our new delivery model and created a checklist to ensure consistency and completeness. We audited the utilisation of our standards before and after the intervention. Results Audit data demonstrated that pre-intervention, only 10% of sampled patients from 2024 received all elements of the care bundle, improving to 74%. Delivery of acute NIV improved with a reduction in both gas and door-to-mask times of 43 minutes and 1 hour 09 minutes, respectively. Conclusion Early results demonstrate an improvement in treatment times. The development of the locally enhanced care bundle enabled the reduction in variation of care and empowered the team to utilise their skills, experience and knowledge. We believe the continuous development of our acute NIV nurse model to now include earlier optimisation and identification of patients is sustainable, cost-effective and applicable to similar services.