Respiratory failure nurse consultant model may decrease hospital days for acute respiratory failure: A single-centre descriptive implementation study

Objectives Non-invasive ventilation has become a well-established treatment for both acute and chronic respiratory failure. With the potential of telemonitoring, the use of non-invasive ventilation has improved the possibilities of treating chronic respiratory failure without physical contact with patients. The aim of this study was to describe the implementation and activities of a consulting respiratory nurse model and to estimate its potential direct budget impact based on predefined assumptions. Setting A University hospital in Finland Participants All consecutive patients requiring non-invasive ventilation initiation or setting adjustment in non-pulmonary wards. Most of these patients had acute or acute-on-chronic hypercapnic respiratory failure. The underlying diagnoses included chronic obstructive pulmonary disease, obesity hypoventilation syndrome, and obstructive sleep apnea. Patients with chronic respiratory failure due to neuromuscular diseases were excluded. Methods This was a single-centre descriptive implementation study conducted in a Finnish university hospital. We implemented a consulting respiratory failure nurse model, whose main tasks were non-invasive ventilation initiation and follow-up visits in non-pulmonary hospital wards, consultations by phone, wireless telemonitoring of patients in non-pulmonary hospital wards and all discharged patients including those initiating non-invasive ventilation in pulmonary wards, counselling patients by phone, and replacement of a broken or unsuitable mask or device for outpatients. Data on activities of a consulting respiratory failure nurse were prospectively collected from 2019 to 2022. The direct budget impact was estimated based on changes in the estimated number of in-hospital days derived from the average hospital stay per patient, patient fees, costs of salaries, and telemonitoring licenses. Results A total of 240 patients initiated non-invasive ventilation in non-pulmonary wards during 2019–2022. Initiating non-invasive ventilation in non-pulmonary wards with the help of respiratory failure nurse and replacing in-hospital follow-up visits with wireless telemonitoring, home oximetry and capillary blood gas analyses, associated with an estimated potential net budget impact per patient per year of 466.57 €, 1017.35 €, 1233.80 € and 1219.67 € in year 2019, 2020, 2021 and 2022, respectively. The number of overnight follow-up visits in pulmonary ward among patients initiating non-invasive ventilation decreased by 61% during the study period. Conclusions Updating the standard operating procedure for respiratory failure patients using the consulting respiratory failure nurse model and wireless telemonitoring was associated with improved care delivery and estimated potential reduction in in-hospital days and direct costs.