Professor Jon Bennett shares his insights on respiratory support units and their potential to revolutionise acute respiratory care for patients
The SARS-CoV-2 pandemic has forced many changes to the practice of medicine and how we run our clinical services. I hope that one of the major learnings that all of us can take away is the value of collaborative working in the NHS.
Covid-19 is a multi-system disease but its hospital presentation has been predominantly lung related, via a pneumonitis, which has required input from respiratory specialist teams. Patients can be severely ill while not needing intensive care, but they may deteriorate at an alarming rate.
Over the past few months, respiratory teams across the UK have provided enhanced oxygen support to covid-19 patients, including high flow nasal oxygen and continuous positive airway pressure on respiratory wards, working closely with intensive care colleagues to step patients up to ICU when needed, but also to step them down when their condition improves, freeing up critical care capacity to ensure patients receive the highest quality of care throughout their hospital journey.
In collaboration with the Intensive Care Society, we have refined this enhanced respiratory care concept into the Respiratory Support Unit model, which has been recognised by the NHS in recent guidance. The RSU is based within respiratory departments, staffed with specialists in all aspects of acute respiratory care who closely liaise with ICU teams to optimise the care of these patients in the most appropriate and safest environment. RSUs have provided enhanced respiratory support to covid-19 patients while preserving ICU capacity.
Figures from NHS Getting It Right First Time showed that when respiratory patients are not looked after by a respiratory specialist or on a dedicated respiratory ward, they spend longer in hospital and experience higher readmission rates. The equation is clear: the right people, in the right settings, provide the best care, and this is what RSUs are about.
It’s easy to draw parallels between RSUs and the previously game-changing coronary care units. In the same way the latter transformed the way we treat people with acute heart disease, RSUs have the potential to revolutionise acute respiratory care for patients.
It’s crucial that the RSUs have robust standard operating policies and the appropriate workforce from the start. It may take some time, as while we know that these skills already exist in our NHS respiratory workforce, the numbers do not. Our goal must be to have dedicated staff with the right skills, and infrastructure, to provide optimum care for these patients.
Their value is likely to be even greater during the winter months when we know hospitals face increased emergency and urgent care pressures. If we can achieve this it will, inevitably, protect other services having to divert their resources away from the patient cohorts that they serve best.
It is imperative that RSUs must be officially recognised, supported and adequately funded, so that they can outlive the pandemic and become worthy Centres of Excellence for all hospitals, delivering the highest quality non-invasive ventilation and oxygen therapy care for the most ill respiratory patients.