The experiences of a rapid access respiratory clinic in Northern Ireland

Abstract

Introduction: Exacerbations of chronic respiratory conditions are the second most common cause of emergency admission to hospital. Healthcare reviews have highlighted the need for an alternative to hospital admission for patients with long-term respiratory conditions. In response, the Southern Integrated Care Partnerships piloted the first Rapid Access Respiratory Clinic (RARC) in Northern Ireland. Aims: (1) Provide early specialist treatment and improved quality of care for patients with long-term respiratory conditions. (2) Avoid hospital admissions. (3) Improve the patient experience. Methods: A Consultant-led multi-disciplinary respiratory service assessed and treated patients with long-term respiratory conditions deteriorating towards the point of admission. A tailored management plan was delivered in the community. Results: From September 2015 to February 2016, 169 referrals were received and 158 patients reviewed. Respiratory conditions treated included: COPD (n=99), bronchiectasis (n=34), asthma (n=27), pneumonia (n=12) and interstitial lung disease (n=10). Treatments provided included: home IV antibiotics (n=16), oral antibiotics (n=53), corticosteroids (n=61), home oxygen (n=17), inhalers modified (n=54), airway clearance (n=107). Twelve patients were admitted. The service prevented 115 referrals to ED. An estimated 78 hospital admissions were prevented saving 336 bed days. There were no adverse clinical incidents. Feedback from patients was overwhelmingly positive. Conclusion: A multidisciplinary RARC can provide high quality, cost-effective specialist care; avoid hospital admissions and improve the experience of patients with long-term respiratory conditions.