Non-invasive respiratory supports delivery in Australia

<bold>Introduction:</bold> Non-invasive respiratory supports (NIRS) including conventional oxygen (COT), high flow nasal oxygen (HFNO), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) are delivered widely in hospitals to treat acute respiratory failure (ARF). This study aimed to examine organisational processes and clinical practices in Australian hospitals for providing NIRS in medical wards and on discharge. <bold>Methods:</bold> Respiratory or general medicine directors working in Australian public hospitals were surveyed between August-December 2023. <bold>Results:</bold> Of 74 hospitals, 62% participated, most being metropolitan (56%), tertiary (48%) hospitals, delivering acute NIRS (93%) in respiratory (70%) or medical wards (61%). Specialised respiratory care units were uncommon (26%) and few utilised written NIRS prescriptions (13-35%). Most had access to medical emergency response teams (89%) and palliative care (80%). Local NIRS guidelines (93%) were common. NIRS training was provided to nurses (65%) and doctors (54%), but was not mandatory (48%). Site NIRS clinical audits were uncommon (11-35%). All offered home NIRS on discharge: COT (91%); CPAP (72%), NIV (63%) and HFNO (6%). Patients needing domiciliary NIRS were followed-up in clinic by doctors (87%), nurses (46%) or physiotherapists (33%), with infrequent outreach nurse visits (43%) or remote monitoring (17%). <bold>Conclusions:</bold> NIRS are used commonly on medical wards in Australia to treat ARF, with domiciliary NIRS variably available. There is substantial variation in practice and organisational processes regarding NIRS delivery which may contribute to variation in health outcomes. Establishing national standards of care should be considered to address these issues.