Leading respiratory physios contribute to BTS Model of Care for Complex Home Mechanical Ventilation

Care should be 'equitable across the community and of high quality'

HMV helps patients with a range of respiratory, neuromuscular and chest wall disorders. These include chronic obstructive pulmonary disease, obesity-related respiratory failure, motor neurone disease and Duchenne muscular dystrophy. Individuals who use HMV as part of their care generally require long-term support that allows them to continue their lives in the community setting.

The BTS said that improving the standardisation and co-ordination of HMV care is an essential factor in ensuring that care is both equitable across the community, and of high quality. Patients leaving hospital should be given clear care plans. 

The document provides guidance in areas such as commissioning, governance, workforce, service and patient pathway development and is informed by the expertise of a multi-professional group of HMV clinicians.

We hope that this sets the standard for ensuring that services providing home mechanical ventilation can be resourced appropriately and have the necessary skills to deliver the best possible care to all patients [Jonathan Bennett, BTS]

 Suggested measures include 

• setting out a novel 3-tier system for organising care – tier 3 being a complex HMV service, tier 2 for patients not meeting criteria for complex care and tier 1 for acute NIV providers 
• establishing minimum staffing levels and referral numbers for complex HMV services 
• advocating for a national registry, to capture data on patient numbers, diagnoses and equipment use
• providing guidance to ensure that care is well co-ordinated between tiers of services and that there is consistency in quality and safety of care regardless of setting 

Many patients currently experience 'poor outcomes'

Ben Messer, a consultant in home mechanical ventilation and critical care medicine, said: ‘Patients with chronic ventilatory failure requiring home mechanical ventilation often have complex clinical needs and include patients with progressive neurological disease, patients in need of tracheostomy ventilation and those requiring ventilation for the majority of a 24-hour period. These patients often experience poor outcomes such as hospital admission, readmission and early mortality.' 

Dr Messer added: ‘It is essential that teams caring for these patients in a community or hospital setting have the resources and skills to enable them to deliver consistently high-quality care. This document provides a roadmap for how this can be achieved, by setting out key information on commissioning, governance, staffing, service design and pathway development for complex HMV services.’

Model is part of a series 

Part of a series, the new Model of Care builds on other BTS guidance produced in recent years in the field of enhanced respiratory care. Examples include Respiratory Support Units: Guidance on development and implementation in 2021, and the Model of Care for Specialised Weaning Units, published in 2023.

The model should be used alongside these other models and adapted suitably for local requirements, the BTS stressed. Although it focuses specifically on England, the principles are applicable in other parts of the UK. 

Professor Jonathan Bennett, BTS president, said: ‘We hope that this sets the standard for ensuring that services providing home mechanical ventilation can be resourced appropriately and have the necessary skills to deliver the best possible care to all patients who may require such treatments.’

The BTS Model of Care for Complex Home Mechanical Ventilation can be found here.  

 To read PhysioUpdate's article about the BTS Winter Meeting, which is being held in London later this month, click