Context Cambridge Breathlessness Intervention Service (CBIS) supports patients with intractable breathlessness due to a variety of conditions. This evidence-based, multidisciplinary, complex intervention promotes self-management of symptoms using predominantly non-pharmacological techniques. Successful self-management reduces Emergency Department attendance (EDA) and inpatient admissions. This service evaluation aimed to investigate the impact of CBIS on hospital attendances, in terms of EDAs and inpatient admissions.
Method The number of EDAs and the number and length of admissions in the six months before, and six months after, first clinical contact with CBIS were recorded for all patients referred during four specific months. Costs of £138/EDA and £306/inpatient bed day were assumed. Other than in cost calculations, a ‘bed day’ was defined as either an EDA or an inpatient bed day. ‘Avoidable attendances’ were EDAs or admissions due to breathlessness alone without an underlying cause requiring intervention in hospital.
Results Data from 74 patients were analysed. There was a significant 43% absolute risk reduction in hospital attendances (p=0.001). There were 3.0 fewer bed days for each patient seen. Avoidable attendances also reduced significantly (p=0.023). The odds of an avoidable attendance was three times lower after receiving CBIS (OR 0.31, p=0.049), and the odds of an avoidable bed day dropped significantly (OR 0.24, p<0.001). The five fewer EDAs and 214 fewer inpatient bed days saves £65 484 or £894/patient.
Discussion CBIS significantly reduced hospital attendance.
The intervention costs £119/patient, suggesting potential overall cost savings. Interestingly, all types of hospital attendances were reduced, not only those deemed potentially avoidable. CBIS supports patients to develop self-efficacy, and improves physical and psychological wellbeing. Therefore, the service may impact hospital attendance for a range of reasons, not only breathlessness. Further work is needed to gain insight into, and increase confidence, in these findings.
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