Respiratory Support Unit (RSU) care is found to significantly reduce rates of patient mortality in latest British Thoracic Society Audit Report

The British Thoracic Society (BTS) has today launched a report summarising the findings of the BTS Respiratory Support Audit, which was the first national audit of enhanced respiratory care for acute hospitals in the UK.

With an ageing population and greater burden of comorbidities, the demand for more complex respiratory care is increasing. Often, due to the limited capacity of critical care services, these patients are managed in general wards despite the severity of their illness. This places further pressure on ward staff, who may not have the capacity or infrastructure to provide adequate support. This was an issue that was further highlighted during the COVID-19 pandemic.

In 2007 the Royal College of Physicians’ Acute Medicine Taskforce recommended the creation of Enhanced Care ward areas specifically designed for patients developing acute medical illnesses. Subsequently, a number of hospitals around the UK implemented respiratory-specific support units.

Based on both an organisational questionnaire and a patient questionnaire, the BTS Audit returned a range of key findings on the benefits and availability of Respiratory Support Units (RSU) care including:

• Hospital mortality was significantly lower for patients in RSU-equipped hospitals (23%) than those in non-RSU hospitals (35%).
• 60% of hospitals had a designated RSU, but only 42% of patients requiring enhanced respiratory care were treated in an RSU.
• 44% of hospitals had a nurse-to-patient ratio below the national standard for enhanced respiratory care.

Early findings therefore indicate that the implementation of RSUs is working well and has the potential to be transformative to the care received by respiratory patients. It will be important, however, to ensure that these units are recognised for the potential of their impact and that they are resourced appropriately in line with national standards.

On the findings Dr Mike Davies, Clinical Audit Lead, said,

“Treatments like acute NIV are life-saving when provided in the right setting at the right time. Respiratory Support Units are special ward areas with round the clock expert respiratory care. Our national audit found that patients in hospitals with an RSU had significantly higher survival rates, especially for patients treated in them. However, limited capacity meant that many patients were still treated in regular wards. It’s time to recognise their potential and ensure RSUs are properly resourced and staffed to transform patient care.”

The findings of this Audit Report have already been useful in informing National Improvement Objectives, which include:

1. Each hospital that admits patients with acute lung disease should have an RSU or RSU equivalent to provide enhanced care. Current 60%: Target 100%
2. Acute respiratory support (NIV, HFT, CPAP) for patients with acute lung disease should be delivered in an RSU or equivalent area with appropriate staffing levels (including HDU and critical care areas) and should not be used routinely in unenhanced, standard ward areas. Current 49%: Target >75%
3. Patients with COPD who experience early NIV failure (within 2 days of starting) in the absence of high-risk prognostic factors (e.g. if NIVO score < 5) should be discussed with critical care to consider the merits of treatment escalation. Current 17%: Target >50%

The ambition is that these National Improvement Objectives will provide a structure for respiratory services around the UK to use as a benchmark in improving the quality of care provided for high acuity respiratory patients.

On the report, Dr Paul Walker, Chair of BTS added,

“This is a seminally important report which shows Respiratory Support Units that are appropriately organised, structured and staffed and have adequate capacity can save the lives of up to 1 in 6 people with COPD who are admitted to hospital with respiratory failure. Akin to the development of Coronary Care Units, these findings are the foundation for improving care for some of the most critically ill respiratory patients.”

Further information on the audit conclusions can be found on the BTS website here.