The benefits of a home non-invasive ventilation retrieval service: Improved effectiveness and environmental sustainability in challenging times
Oakes A, et al.
Abstract
We developed and delivered an innovative follow-up service for home users of non-invasive ventilation (NIV) machines to support home NIV delivery and improve cost-effectiveness and sustainability during the COVID-19 pandemic. Between Feb 2019 and November 2020, 92 post-acute patients were issued with home NIV; 25 (27%) out of the 92 patients had unused NIV machines successfully retrieved. This project demonstrates that what is good for the patient can be good for the planet and good for the pocket,
We know that the clinical effectiveness of long-term home NIV outside of neuromuscular respiratory failure is variable and problems around adherence/compliance have been reported. Furthermore, current cost-effectiveness estimates assume each NIV machine is for individual patient use, that is, a single machine spending its entire working life with one patient without being recycled. Therefore, recycling of NIV machines has the potential to improve cost-effectiveness. Additionally, it was beneficial to properly recycle the machines to increase machine availability for more patients, which could facilitate earlier hospital discharge and prevent readmissions.
We established and trialled an innovative home NIV follow-up service to improve the effectiveness and sustainability of home NIV by improving the safe retrieval and recycling of home ventilators. The service was initiated during the COVID-19 pandemic in September 2020, principally to reduce footfall to outpatients and prevent hospital admissions, and it enabled the home NIV team to proactively review every post-acute NIV machine and recycle the unused ones. Each post-acute home NIV machine issued between February 2019 and November 2020 from our acute NIV unit was reviewed between December 2020 and May 2021. Furthermore, remote monitoring of patient compliance and efficacy was instituted where they had home Wi-Fi facilities and patients consented (over 70% of patients), via the Remote monitoring "AirView" platform. Patients received up to two home visits from a specialist physiotherapist together with a variable number of telephone calls (2–6), prompted by telemonitoring in most cases to enhance compliance.