Q Exchange
Tackling health inequality for chronic respiratory failure: Home Ventilation Outreach
- Winning idea
- 2023
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
Patients with chronic respiratory failure may require long-term treatment with ventilator machines. These patients are at high risk of deterioration, requiring regular specialist review.
Additional long-term health-conditions are common, causing poor mobility, reduced quality of life, depression and mental-health conditions. Advanced ‘multi-morbid’ disease means that many patients become housebound. Patients from culturally diverse and socially deprived areas may have reduced attendance at routine follow up.
Inability to access in-hospital services means patients are not assessed, resulting in lower treatment adherence and increased emergency admissions, which can be life-threatening.
We propose an adaptive ‘Home Ventilation Service’ providing assessment and treatment at home.
A sample of our patients revealed, per patient, per year:
– Average 6 admissions, >100 days in hospital
– Estimated healthcare cost of >£45,000
– 50-100 of our patients may benefit from a ‘Home Ventilation Service’.
– A previous short unfunded feasibility ‘Home Ventilation Service’ pilot was positively received by patients (100% positive feedback)
What does your project aim to achieve?
A ‘Home Ventilation Service’ with the goal of improving equitable access to monitoring, interventions and support, reducing hospital admissions and improving quality of life. It would improve accessibility for housebound patients to healthcare professionals. The project will allow sufficient data collection to submit a business case for a permanent ‘Home Ventilation Service’.
The objectives of a ‘Home Ventilation Service’ would be:
– improve access to specialist ventilation service care for patients unable to attend hospital appointments
– reduce hospital visit burden
– improve patient centered outcomes (satisfaction, quality of life)
– improve patient clinical outcomes (treatment adherence, treatment response)
– reduce emergency hospital admissions
– reduce planned admissions for assessment and optimising treatments
– reduce outpatient appointments missed
– improve patient outcomes and organisational financial benefits
How will the project be delivered?
Home visits would be offered by a Specialist Physiotherapist in Ventilation, to all patients on home ventilators, unable to access outpatient appointments. Patients would be offered 2-4 visits a year, with additional visits as required. Joint visits could be made with specialist Consultants in Ventilation, Respiratory Nurses, the home oxygen team and Palliative Care.
Visits would include holistic assessments, blood tests, sleep studies and ventilator data download and assessment. Gathered patient feedback would tailor the visit to individual needs.
Treatments may include ventilator and oxygen prescription and set up, ventilator settings optimisation, medication reviews, onward referral to specialist teams (physiotherapy, social worker etc), supporting family members and carers with ventilator treatment and supporting patients in their end-stages of life (palliative care joint working, Advanced Care Planning).
Impact will be measured by patient satisfaction questionnaires and data on hospital admissions, including frequency, length of stay and number of missed outpatient appointments.
How is your project going to share learning?
– Shared within the Q Community via updates on the online platform
– Shared with local and regional QI forums
– Shared within the wider Respiratory team at Kings College Hospital; including submitting a business case to demonstrate ‘Value Based Health Care’, targeting outcomes that matter to patients with positive cost implications.
Shared within local and wider ICS network managing long-term conditions / ‘multi-morbidity’ at Kings College Hospital, that may benefit from home care services where outpatient attendance is also challenging.
– Shared with the recently developed health inequality working group at King’s College Hospital
– Shared between Kings Health Partners (Kings College Hospital, Guy’s and St Thomas’s, Royal Brompton and Harefield)
– Shared with other NHS Ventilation Services
– Social media (Respiratory / Trust social media accounts)
– Professional forums:
o Appropriate relevant conferences
o London Respiratory Network meetings
o Association of Chartered Physiotherapists in Respiratory Care
How you can contribute
- - Provide feedback on our idea, suggest improvements or ways to increase impact
- - Highlight networking opportunities with colleagues in Respiratory or Ventilation Services
- - Highlight collaboration opportunities with colleagues delivering home care services in other ‘multi-morbid’ / long-term health condition services
Plan timeline
| 30 Jun 2023 | Recruitment of part time Band 7 physiotherapist for project (1 year) |
|---|---|
| 4 Sep 2023 | Project starts, first home visit |
| 26 Feb 2024 | Interim data analysis (6 months) preparation for business case |
| 31 May 2024 | Completion of business case |
| 2 Sep 2024 | Project write up and shared learning; project dissemination |
Project updates
31 Jan 2024
We have learned a lot with our project so far, mainly how to manage delays to project start!
As our project requires recruitment of new personnel, this brings the need to pass internal new post approval processes and we are now eagerly waiting for executive approval before we can formally advertise to the post.
In the meantime, we have the job description ready, an interview panel agreed, essential training planned, and we have thought about logistics of conducting the home visits!
Comments
Meera Kamalanathan 22 Mar 2023
This is a fantastic project. This group of patients are vulnerable, and anything that can be done to reduce their chance of a hospital admission is truly worthwhile. This project can help to improve quality of life by allowing patients to access the specialist care they need at home, support families/carers and reduce hospital attendance (both for outpatient appointments and admissions).
Sarah Burns 21 Mar 2023
From a primary care perspective, this is an excellent project and supports those patients who are housebound or where there are other barriers to accessing secondary care respiratory services and who may also make frequent contact with primary care. As well as improving patient care and reducing emergency hospital admissions (and therefore secondary care costs), I think this service will be highly valued by Primary Care clinicians as it will greatly enhance the community based care of these complex patients.
Rachael Robinson 21 Mar 2023
This is a well thought out project that will make a huge difference to patients. The patients will be able to reduce hospitalisation and still get the support they need in their own homes. It gives the patient more control in their condition.
Christopher Primus 21 Mar 2023
As a heart failure consultant, a significant proportion of my patients suffer from sleep apnoea. For patients with both HFrEF and HFpEF, the cardiovascular benefits of addressing this comorbidity are significant, with heart failure hospitalisations adding to the economic impact of sub-optimally treated sleep-disordered breathing. A Service like this could work closely with our specialist nurses to improve the overall care provided for our shared patients, and undoubtedly have a significant impact on morbidity and mortality.
An excellent patient-centred initiative.
Dr Alex Wilkinson 21 Mar 2023
Across Herts we have patients travelling long distances, often to Cambridge to access these therapies. This, like so many other examples, results in poor patient experience, worsening inequality, waste of resources, high carbon footprint, and lower quality care. Would love to see this funded and to see what you learn from it.
Colette Davidson 21 Mar 2023
This sounds like an excellent project. So many of these patient remain hidden until they require emergency admissions for an acute deterioration. The co-morbidities that mean they require ventilation services are often the very reason that they cannot attend appointments, and telephone reviews only allow a partial assessment. A home ventilation team seems like a great solution to these challenges.
It makes instinctive sense that setting up and review oxygen and ventilation services at home, where they are used, will help address some of the barriers that patients face when using these machines. This will improve patients outcomes.
I also think incorportating palliative care into this plan is really important as I find it is often under-recognised how frail these patient are.
Laura Elliott 28 Mar 2023
Thanks Colette. I absolutely agree- joint working with palliative care would be so important and beneficial for these patients. Advanced care planning discussions are often best suited to take place at home, which would be a big positive to joint working with palliative care.
Dan Wheeler 17 Mar 2023
This sounds like an incredible project. Real potential for increasing equity of access to specialist service, reducing inpatient burden and addressing a serious gap in patient care at the same time. Good luck with it!
James Heed 16 Mar 2023
This is a fantastic, forward-thinking project! Enabling access to specialist care and facilitating a better quality of life for a cohort of more vulnerable patients, whilst addressing inequality and optimising care pathways.
Brilliant.
Raj Madula 9 Mar 2023
This is a fantastic initiative! Many of these patients have complex health needs with multiple co-morbidities. Attending outpatient appointments is a considerable challenge for them and in some cases, not even a possibility.
Monitoring patients at home has directly improved patient care, prevented hospital admissions, freed up outpatient slots and facilitated safe and early discharge from hospital. Much to the delight of the patients concerned!
This is most definitely the future of healthcare and this model can be readily implemented across the NHS!
katie walker 7 Mar 2023
This project is really delivering what matters most to patients.
Alex Porter 7 Mar 2023
What a fantastic idea and method to aid in the provision of care at home and help prevent costly hospital admissions, and what a great way to enhance patient experience and satisfaction too.
Caoimhe Nic Fhogartaigh 6 Mar 2023
LJ and team, this sounds great and a very much needed patient-centred service which will have benefits for the patient as well as the wider healthcare system. Good luck!
Amy Dewar 6 Mar 2023
Great initiative which would certainly meet the unmet healthcare needs of an underserved group of patients.
Surinder Birring 6 Mar 2023
A great project for a underserved group of patients and delivered by a talented team with experience. The vision is clear and backed by pilot data. There is real potential to upscale the protocols of this project to mainstream clinical practice.
Sarah Fitzgerald 6 Mar 2023
Fantastic project, and hope this is the start of developing a permanent home ventilation service! Hugely beneficial to many of the housebound patients using these devices to optimise their ventilation, improve quality of life and reduce hospital admissions.
AMADEA HEITMANN 6 Mar 2023
Such an important project to reach out to patients in the community early to prevent unnecessary admissions. Preventative measures especially in a vulnerable group is of unmeasurable value.
Clare Rossall 3 Mar 2023
The proposed project is excellent. This service is absolutely essential for any LTV service. Once you've started this project you'll wonder how you ever managed without! Good luck.
Patricia Macedo 3 Mar 2023
This is an excellent project. It is really a case of win/win for all involved. Patient care and outcomes will improve, and resources will be freed up at the hospital, increasing capacity to see more patients. We already offer a home ventilation service to our CF patients and it makes a real difference to them.
Sabrina Bajwah 3 Mar 2023
As a palliative care consultant, I often see these patients who have been admitted to the acute sector. They usually die in hospital as services at home do not meet their needs. This is a great proposal to directly address these unnecessary hospital admissions. It would enable us to facilitate patient's end-of-life wishes, and support better delivery of care in the community.
Geoffrey Warwick 3 Mar 2023
This sounds like a great idea - it would really make a difference to the patients involved. Good luck.
Sophie Hinds 3 Mar 2023
The most complex patients on home mechanical ventilation often can’t access the out patient service for the care they need. A home visit service reduces healthcare inequalities and delivers care closer to home. I work in the Bristol Home Mechanical Ventilation team and we offer home visits to these services users when appropriate. It’s an essential part of our service and this looks like a great project!
Dr Debra Seow 2 Mar 2023
I’m from Singapore, and I am a respiratory and critical care physician with a subspecialty interest in chronic ventilation. Any project that aims to improve equitable access to home vent/NIV outreach services has my full unstinting support.
Laura-Jane Smith 3 Mar 2023
That’s great to hear Debra. Thanks for your support! As you say, this patient group is underserved. It sounds like there would be interest in sharing learning internationally, so we will need to think about how to share widely.
Caroline Hare 2 Mar 2023
A fantastic project! Services should be designed for patients and allow equity of access for all, not just for those who can travel. There are huge gaps that this project would start to address. I’m very interested to see how it develops.
Laura-Jane Smith 3 Mar 2023
Thanks so much for your comment Caroline. Addressing health inequalities is really at the core of this project.
Keri John 2 Mar 2023
Improving care at home for those who are most vulnerable is paramount. Providing care at the right time, in the right place for those who need it, underpins our clinical practice, as well as saving money in the long term.
Rishalan Moodley 2 Mar 2023
Great project! Like the idea of community base care - ‘bringing care closer to home’ and preventing hospital admissions. Your service will bring accessibility and quality of life improvement to a cohort that is severely under served. I hope that you are successful with implementation- the patient will be the greatest winner from this.
Debbie Field 2 Mar 2023
Brilliant project. I am a great believer in keeping patients at home and the hospital goes to them for any long term condition. I have run and developed our outreach service for home ventilation for the past 7 years at the Royal Brompton and it makes such a difference for patients with complex ventilation needs.
In the long term it is cost effective and gives the patient a better quality of life and keeps them at the centre of care, enabling the patient to actively be involved in their care.. Truly multi-professional with AHP / Nurse lead.
This is the future for the NHS!
Well done!
Debbie
Laura-Jane Smith 3 Mar 2023
Thank you Debbie! Any tips on capturing the right outcomes effectively would be much appreciated. We’re really keen to develop the evidence base so that we can advocate for home services being the standard for this patient group.
Catrin Emery 2 Mar 2023
Very pleased to see such a great response from the unfunded pilot project! I hope the service can progress as you've planned - it's a brilliant idea !
It's perfectly in keeping with the NHS Long Term Plan for treating patients in the community, reduces inpatient bed pressures, and is generally well received by patients. Well done team!
Sam Orridge 2 Mar 2023
Important work. I love to see anything that takes patient care outside of the hospital setting.
Flora Charlton 2 Mar 2023
Sounds like a really important piece of work, really looking forward to hopefully hearing more about how it goes
Kate Myall 2 Mar 2023
An excellent project serving a group of patients with significant unmet need and breaking down barriers between community and hospital care.
Nuriah Haleem 2 Mar 2023
What an absolute brilliant idea! Providing access to specialist care to those who are housebound, as well as reducing hospital admissions! Not only that, I can see this hugely improving the quality life of all these patients who would benefit from the service!
I fully support this project and hope that it will receive the essential funding to carry out this amazing work! Looking forward to seeing where this will go!
Michael Bartley 2 Mar 2023
This sounds like such an exciting project hopefully reducing admissions and the risks that come with Hospital admissions to a vulnerable patient group. Also as previous comments have highlighted, improving quality of life for the patient group.
Harriet Bryce 2 Mar 2023
An excellent project initiative and idea. Looking at the data on the patient sample taken, there is clearly a need to reduce hospital admissions and resultant cost implications in this housebound patient population and improve overall patient satisfaction and equitable access to high quality care and support.
The results of this project will hopefully enable a long-term home ventilation service for patient's at King's, but also support the implementation of similar services nationwide. I look forward to seeing the results.
Nikki Rennie 2 Mar 2023
A great initiative bringing quality care to patients in their own homes
Michelle JohnsonMichelle Johnson 2 Mar 2023
Great initiative. Working with the home oxygen service and regularly reviewing pts at home with NIV who are unable to attend clinics this service is invaluable. Thank you
Jeanne Devaney 1 Mar 2023
Very interesting & a great idea! I hope the project gets the funding needed to support implementation
Gary Chan 1 Mar 2023
Taking specialised care into the community to a very vulnerable cohort of patients, what a great project.
Jimstan Periselneris 1 Mar 2023
Sounds like a brilliant project. Patients on domiciliary NIV are often frail and can be nearing the end of their lives. Anything that can be done to maximise quality of life and allow more time for these patients to spend with loved ones and in comfortable environments is worthy of investment.
Bill Bournes 1 Mar 2023
This seems like an excellent, well thought-out project to reduce hospital visits and improve patient outcomes in their own home! A great read, and I certainly hope this project gets the funding to deliver essential care to patients.
Chelsea Farrell 1 Mar 2023
Very interesting project highlighting a major need in respiratory services
David Peter Walder 1 Mar 2023
This is a fantastic looking project which will clearly be beneficial to a population that are hard to treat and face difficulties accessing healthcare. Hospital admissions for decompensated respiratory failure are prolonged, expensive and distressing for patients. The ability to deliver a proportion of this service at home has to be the direction of travel.
Will McNulty 1 Mar 2023
Great project. This group of patients often have a relatively short life expectancy and your data shows they can spend a large part of the year in hospital. This is an exciting project that will help improve quality of life by allowing patients to access the specialist care they need at home, hopefully reducing admissions.
Ali Bogar 1 Mar 2023
Very interesting.
Kate r 1 Mar 2023
What an excellent QI project to meet the needs of those patients who need appropriate safe and well led care at home to prevent unnecessary hospital admission.
Excellent project hope all goes well.
Massimo Barcellona 1 Mar 2023
Taking care to patients at home... and addressing inequalities. A win win for what sounds like a great project.
Victoria Jackson 1 Mar 2023
This project, focussing on development and implementation of a a home NIV outreach service, looks to provide multiple benefits. Most importantly it would serve to improve patient care and reduce health inequalities within this patient group, but with the additional cost-saving benefits proposed.
The findings would not only help to influence an internal business case for the organisation delivering the project but would also be useful to guide similar projects / service developments within other organisations.
I hope it is successful in achieving the funding requested to support implementation and I would be keen to be sighted of outcomes.
Biba Stanton 1 Mar 2023
This sounds like an exciting project to address a real problem with equity. And hopefully you will be able to show that ultimately it saves money by reducing unplanned admissions...
Rebecca Christie 1 Mar 2023
This looks like a great project which will increase the access housebound patients have to hospital services, and ensure they have equitable access across the board. I can see this making a significant difference to the number of hospital admissions these patients have.
I'd like to express my support for this project and I hope to see the amazing work that comes from it!
Cheryl Levy 1 Mar 2023
It is good to see so many amazing projects coming through King's College and also the support of our community. I look forward to seeing this project continue to develop and please do not hesitate to reach out for me (KCH Quality Improvement - QI) if I can support in any way.
Marcus Pittman 1 Mar 2023
People who require home ventilation often have severe breathing difficulties, and thus find visits to hospital for appointments very difficult. Not being able to access healthcare due to the symptoms related to serious breathing problems is a serious inequality issue.
They are also a group at high risk of admission to hospital, through the emergency department; which can end up being a very time consuming and expensive way to deal with problems arising from ventilation.
A home ventilation service will help to tackle both problems, improving quality of and access to care, whilst preventing costly and potentially distressing emergency admissions to hospital.
Vincenta Leyden 28 Feb 2023
Sounds great. Would love to hear more about the project - particularly and potentially of benefit to the MND community. Thanks for sharing.
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