Optimizing NIV initiation in acute hypercapnic respiratory failure: a multisystem approach reducing delays

<bold>Introduction:</bold> British Thoracic Society (BTS) quality standards state NIV should be initiated within 60 minutes of decision to start treatment. This study evaluated our hospital’s adherence to BTS standards and implemented interventions for improvement. We aimed to improve doctors’ awareness of guidelines and increase confidence in initiating NIV to improve care. Methods As part of a QIP, we conducted a retrospective review of patient records after three interventions were implemented: 1) a structured education program; 2) establishment of a 24-hour NIV phone line and dissemination of NIV guidelines through posters; 3) repeated delivery of the education program with daily emphasis on identifying a designated vacant bed for NIV during ward board rounds. Data was collected after each intervention. <bold>Results:</bold> Baseline analysis showed only 59% (n=16) patients received NIV within the 1 hour standard. Delays (range 0.5-9.5 hours, median 2.5 hours) related to decision making and transfer to an appropriate area. After intervention 1 there was an improvement: 73% (n=8) received NIV within 1 hour, reducing the median delay to 1 hour. Data collected after intervention 2 showed a sustained improvement, 70% of patients started NIV within 1 hour (n=14). However, the median delay increased to 3.5 hours (range 0.5-7.5 hours). Intervention 3 led to a sustained change. 65% of patients received NIV within an hour (n=17) with a median delay of 1 hour (range 0.5-5 hours). <bold>Conclusion:</bold> Using education alongside streamlining the NIV pathway has reduced delays in initiating NIV. Despite the challenge posed by operational pressures, our efforts underscore promising opportunities for improvement in patient care.