P232 Efficacy of post-acute domiciliary non-invasive ventilation (NIV) set-ups

Introduction Post-acute Domiciliary NIV (i.e. following a hospital admission requiring acute NIV) has been shown to reduce hospital admissions and Length of Stay (LOS) for persistently hypercapnic COPD patients (Murphy et al. JAMA 2017; 317(21):2177–2186. doi:10.1001/jama.2017.4451) but the data on the impact of post-acute domiciliary NIV on the full spectrum of conditions in real life practice is scant. We set out to assess its effect on our patient community in the number of admissions and LOS by comparing the periods two years prior and two years after set-up of domiciliary NIV for each patient. Methods As part of an audit, we identified the patients who had domiciliary NIV set up between April 2012 and April 2014. Electronic and paper patient records were then used to assess the number of admissions and LOS of this group of patients for the 2 years before and 2 years after domiciliary NIV was set up and analysed using Wilcoxon signed-rank test. Results There were 88 intended new Post-acute Domiciliary NIV set-ups; 4 were excluded as NIV was not initiated (as intended during the post-acute phase) on discharge. The total number of admissions for this cohort of patients fell from 164 for the two years preceding set up, to 79 in the two years after set up. This correlated to a total of 1794 days of inpatient treatment pre domiciliary set up, reducing to 600 inpatient days for the two years post domiciliary NIV (p=0.00000174), a reduction of 66.5%. In addition to this the mean length of stay per admission fell from 10.9 days pre domiciliary NIV, to 7.6 days post domiciliary NIV, a reduction of 30.6%. Of the original 84 patients 62 survived 2 years; out of the 22 patients who died within the 2 years, 4 were readmitted, in a total of 7 admissions and total length of stay 99 days. Conclusion Our results show a statistically significant reduction in both the number of admissions and the length of stay per admission in the cohort of patients after initiation of Post-acute Domiciliary NIV.