A multi-centre quality improvement project to assess the impact of a standardised NIV care bundle on mortality outcomes in patients with acute type two respiratory failure

The evidence for NIV is clear; however, real-world outcomes fall short of those demonstrated by clinical trials. We developed a five-step care bundle in line with BTS quality standards to standardise management and guide clinicians through the first few hours of NIV care. This was combined with staff training initiatives. The project aimed to reduce acute NIV mortality to 10%. Although this target was not met, the project delivered a 7% reduction in mortality from 28% to 21% equating to 143 fewer deaths in 2023 compared to 2022. The project also delivered increased staff confidence. Through this project we have demonstrated that early, effective NIV, in appropriate patients, delivered in a standardised way by confident and competent staff, improves outcomes.