BMJ Awards 2021: Respiratory team of the yearBMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2203 (Published 16 September 2021) Cite this as: BMJ 2021;374:n2203
- Matthew Limb, freelance journalist
- London, UK
Respiratory high care team—Gloucestershire Hospitals NHS Foundation Trust
Experience of the first wave of the coronavirus pandemic led clinicians to plan to deliver the majority of respiratory support in wave 2 through non-invasive methods. A respiratory high care unit was created which aimed to protect intensive care unit (ITU) beds for the sickest covid patients and essential non-covid work. The approach required a shared model between respiratory and intensive care, with excellent relationships and flexible ways of working that broke down traditional silos within hospital, says Henry Steer, respiratory clinical lead. “This allowed us to better align our respiratory and ITU resources to patient needs and resulted in improved care,” he says.
Equipment and staff were shared between ITU and respiratory high care, with flexible rostering of up to two ITU nurses per shift to respiratory high care. Clinical protocols were also shared to ensure consistent care irrespective of location. There were regular joint planning and multidisciplinary team meetings. Steer says joint working facilitated “upskilling” of the whole nursing team as wave 2 unfolded. Respiratory high care was able to expand into a second ward. At the peak, 30 patients were on continuous positive airway pressure or nasal high flow oxygen. Considerably more respiratory support was delivered on respiratory high care than ITU in wave 2 (304 v 97 episodes) compared with wave 1 (96 v 91), preserving ITU beds for the sickest patients. More than 70% of ITU patients were invasively ventilated compared with around 50% nationally. No major cancer surgeries were cancelled. Survival to hospital discharge for respiratory high care and ITU patients was higher than reported in Intensive Care National Audit and Research Centre (ICNARC) audit. …