CUH lung disease mortality rate was twice that in UK

The mortality rate among inpatients with a chronic lung disease at a Cork hospital was at one stage more than double the rate in Britain, according to figures presented by doctors petitioning for a new respiratory ward.

The patients, who were suffering from chronic obstructive pulmonary disorder (COPD) — a progressive lung disease that makes it difficult to breathe — also spent, on average, three days longer in hospital than patients in Britain.

The figures, from 2007 audits, appear in a statement of need drawn up by doctors in support of an application for a 20-bed adult respiratory and cystic fibrosis (CF) ward at Cork University Hospital to replace the existing 11-bed unit. The statement was drawn up in Jan 2012.

In relation to a request for updated COPD mortality rates — in 2007 it was 17% at CUH, compared to 7% in Britain — the HSE said the figures were “not routinely collated”.

Doctors said the stresses on the current system meant there was a need to develop “a dedicated respiratory high-dependency unit to appropriately treat patients with respiratory failure with non-invasive ventilation [NIV]” — breathing assistance via a mask rather than a tube down the nose and into the airways.

In the Jan 2012 statement, doctors said: “Currently between one third and a half of patients treated with NIV are treated on non-specialist wards by nursing staff with little, if any, formal training in NIV.

“Predictably, our own audit has demonstrated poorer outcomes and longer stays among this cohort.”

Doctors said that although international best practice recommends this service is provided in a dedicated area by specialist, trained staff, “this clearly does not happen, as these patient are frequently admitted under non-respiratory teams on wards... where the nursing and medical staff are completely unfamiliar with the techniques and equipment leading to poorer outcomes”.

Over the last two years, the respiratory team has purchased modern equipment to expand the service and ward staff are undergoing training sessions “to ensure a fully trained nursing complement”.

The CUH 2007 COPD audit showed 20% of patients admitted needed NIV.

Doctors said a new ward would allow them to treat patients in a defined area, facilitating the development of “a dedicated nursing skill base which should improve clinical outcomes, shorten length of stay, and lead to increased retention of nursing staff with a respiratory interest”.

In response to queries from the Irish Examiner, the Health Service Executive said that all patients, respiratory and CF, who require NIV are treated by nursing staff “with the core competencies”.

The new respiratory ward should have been built by now, but the €2.3m to fund it has not been handed over by CF charity Build4Life because the hospital is refusing to ringfence beds for CF patients.

This is despite the fact that the statement of need highlighted the need “to increase the number of dedicated, ‘ring-fenced’ single side rooms for adult cystic fibrosis patients who require admission and isolation”.