IntroductionPatients who had tracheostomy in intensive care unit (ICU) as part of acute admission and are slow to wean from ventilation are admitted to our acute respiratory care unit (ARCU). We evaluated the long-term outcomes of attempted weaning from ventilator support in terms of underlying diagnosis, comorbidities, length of stay (LOS), level of support at discharge and one year survival.MethodsTwelve patients admitted to ARCU as a step-down from ICU between January 2014 and December 2016 were included. Patients were identified using discharge database and data was collected from electronic records and patient notes. Patients were excluded if they had tracheostomy inserted on a previous admission.ResultsThe patient demographics, length of stay on ARCU and primary diagnosis leading to respiratory failure requiring intubation and subsequent tracheostomy and the LOS on ICU and ARCU are described in Table 1. All but two had significant other comorbidities including neuromuscular disorders, COPD, cardiovascular disorders and OSA. No patients died in hospital. Eight (67%) patients were discharged without any ventilatory support after decannulation, Two (17%) required overnight ventilation and were discharged with tracheostomy ventilation. One patient was transferred to the neuro rehabilitation unit and one to a different ARCU with tracheostomy (self ventilating). Complications during weaning included pneumonia, pneumothorax, delirium, persistent secretions/mucus plugging. At 12 months post-discharge two (17%) patients were dead; seven (58%) were not on any ventilatory support; three (25%) were continuing with tracheostomy ventilation.Abstract P131 Table 1Age (mean+/- SD, years)56+/- 17 Malesn=8Femalesn=4LOS in ICU pre tracheostomyMedian=8, Range=2–22Mean- 9+/-6LOS in ICU post tracheostomyMedian=34, Range=7–96Mean 41+/-30LOS in RCU post tracheostomyMedian=7, Range=1–93Mean 21+/-33 Primary Diagnosis (n=12)Pneumonia6Post-procedure/surgery3COPD1ARDS1Other (Cardio-respiratory arrest)1ConclusionRespiratory weaning from tracheostomy ventilation represent a heterogenous group which is complex with diverse aetiology and multiple comorbidities. There is a considerable variation in the LOS on ARCU and is often unpredictable. Although more than two third of patients wean successfully on our unit it carries a high one year mortality. LOS is influenced by the complexity of discharge planning. We are not a dedicated weaning unit and our unit is not staffed to look after more than two tracheostomy-ventilated patients at any one time which combined with prolonged stay slows down patient flow from ICU to ARCU and from ARCU to the wards. Multidisciplinary approach and dedicated weaning units are needed that is able to look after complex needs in hospital and coordinate complex discharges.

BackgroundElectronic clinician-to-clinician advice service (E- consultation) is a telehealth modality1 that enables the primary care clinicians to seek advice from specialists through a shared electronic system (Systm one). This is a mode of non-face to face consult and for less complex cases this service potentially reduces unnecessary clinic referrals and provides an efficient specialist input thus improving patient care.2,3 This was first piloted in NHS Yorkshire and Humber in 2012. In agreement with clinical commissioning group (CCG), our trust implemented this in March 2015 and we have evaluated the impact of this service.MethodWe retrospectively reviewed all patients who had an e-consultation (March 2015 – January 2017). Patient demographics and clinical information were retrieved from systm one. The referral to clinician response time, content of the referrals, the outcome of the e-consultations and the cost analysis based on nationally agreed tariff (Respiratory treatment code- 340, £23 per e-consultation) was evaluated.Results324 patients (63+/-16 years, males- 54%) had an e-consultation. Clinicians completed these referrals in 3 days (IQR=1–7 days, range=0–32 days). The content of the e-consultations were classified under five domains- investigations (n=91, 28%), radiology (n=114, 35%), medications (n=32, 10%), miscellaneous (n=6, 2%) and mixed (n=81, 25%). 63% (n=204) of the referrals were initiated by the general practitioner, 25% (n=81)- practice nurses and 12% (n=39)- trainees. 32% (n=105) of the e-consultations were recommended for a formal clinic review. Since implementation, this service has generated over £7000 to the trust.Discussion and conclusionsThis novel service is available for routine, non-urgent specialist advice only and is easy to access. This new approach does not seem to have a significant burden to our other ongoing clinical activities. It provides an opportunity to screen potential formal referrals and identifies the need for specific investigations prior to treatment. However a third of all e-consultations were recommended for a clinic review. Further discussion with the CCG is ongoing to improve the service by having a criteria led referrals and to promote training and awareness of this service.References. L.A. Care Health Plan2012.. Harno et al. Journal of Telemed Telecare6(5):320–9.. Kim et al. Journal of General Internal Medicine2009;24(5):614–619.