GIRFT has shared new best practice guidance to help improve the care of children on long term non-invasive ventilation (LTV) at home who may require admission to hospital.
An expert working group of more than 30 paediatric clinicians and managers from paediatric respiratory services, paediatric critical care operational delivery networks (ODNs) and LTV networks came together to develop the guidance, which offers best practice actions in areas such as avoiding hospital admissions, the most appropriate care setting and inpatient unit, and hospital monitoring and documentation.
While children requiring LTV can have a broad range of medical conditions and levels of required support, this GIRFT pathway covers children with more complex needs requiring non-invasive ventilation (NIV), typically Bi-Level Positive Airway Pressure support (BiPAP), and who are at home but may need readmission to hospital. A future guideline will cover children on a tracheostomy-LTV pathway.
The guidance describes how the risk of readmission can be reduced by ensuring that a child and family have appropriate arrangements in place at home to maintain stability and a safe environment, with a clear plan in the event of deterioration. The guidance advocates for parents’ and carers’ need for appropriate training and to have demonstrated their competency before their child is discharged, with the training refreshed annually.
A delivery checklist of all the key quality actions is included in the guidance, also offering actions for improving commissioning, LTV equipment and coding.
The guidance follows the findings of the GIRFT Paediatric Critical Care national report (2022), which reported that children on LTV are often admitted and remain in ICU when they could be looked after in a more suitable ward environment. At the time of the report, children on LTV represented 3.8% of PICU admissions and utilised 9.6% of total PICU bed-days across England.
GIRFT’s national review of services found that in systems with effective step-up and step-down options, LTV patients were just 2% of total PICU admissions and bed-days, compared to 8.4% of admissions and 33% of bed-days in less efficient systems.
The new guidance is clear that children on LTV who are stable but require hospitalisation for a minor illness, non-respiratory co-morbidity or other reason should wherever possible be admitted to a suitable District General Hospital (DGH) bed, provided the staff are trained to care for a child on an LTV pathway. The guidance also considers the benefit of allowing paid carers to support the child and family during an admission.
When admitted to a specialist respiratory/LTV centre children should be cared for in a lower dependency clinical area, such as a respiratory ward, or LTV/transitional care unit, rather than a critical care unit, unless their clinical stability necessitates admission to critical care.
