The effect of Post-acute domiciliary non-invasive ventilation (NIV) on hospital admissions and length of stay (LOS)

Introduction: Post-acute Domiciliary NIV (i.e. following a hospital admission requiring acute NIV) has been shown to reduce hospital admissions and LOS for persistently hypercapnic COPD patients (Murphy et al. JAMA 2017;317(21):2177-2186. doi:10.1001/jama.2017.4451) but there are few studies of the impact of post-acute domiciliary NIV on the full spectrum of conditions. 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 2years before and 2years after domiciliary NIV was set up and analysed using Wilcoxon signed-rank test. Results: There were 88 new Post-acute Domiciliary NIV set-ups; 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%. 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.