Acute Respiratory Assessment Unit : A Novel Quality Improvement Initiative

Title: Acute Respiratory Assessment Unit : A Novel Quality Improvement Initiative
Author(s): T Byrne Dr A Granitsas Dr H McLoughlin
Institution: Portiuncula Hospital
Poster: Click to view poster
Category: General Respiratory and Sleep
Abstract: Background
Burden of respiratory disease is challenging. Only 1/3 to 1/2 of individuals with airflow obstruction have a formal diagnosis1
Often respiratory diseases are managed in primary care, without access to diagnostics. Early diagnosis and pharmacological intervention are essential in achieving better clinical outcomes for patients.
We piloted the introduction of a Respiratory Assessment Unit (RAU) within the medical assessment unit. The unit facilitated early review of patients with suspected and complex respiratory disease. The RANP facilitated a full clinical examination with access to diagnostics required. Patients received an accurate diagnosis, education, health promotion and commenced on appropriate medication.
46.5% (n= 20) were diagnosed with COPD
14 % (n=6) were diagnosed with Asthma.
39.5% (n=17) were referred with other respiratory concerns such as;
• Lung Nodules: In high risk patients
• OSA: Patients with recent cardiac event/ TIA
• Cough: Undetermined origin
• Haemoptysis: Un resolving

11% (n=5) required admission
88% (n=38) were discharged
This pilot in a level 3 hospital corroborated that an RAU provides;
• Early accurate diagnosis
• Improved patient experience
• Reduced Consultant waiting list time
• Potential to reduce ED presentations and/or Hospital Admissions
A fully resourced RAU within an MAU could provide complex disease management and aid in hospital admission avoidance.
Comprehensive local respiratory service should include;
Inpatient Review
• Integrated Care
With increasing complexity we estimate that the admission rate would be 25% in keeping with the Acute Medicine Programme KPI.

Future Recommendations
A permanent RAU would;
• Improve patient experience
• Reduced waiting lists.
• Reduce ED presentations/Hospital Admissions