A series of national audits run by the British Thoracic Society (BTS) in 2013 and 2010 showed progressively worsening outcomes from Non-Invasive Ventilation (NIV) acutely delivered in NHS hospitals. There has been a slight improvement in mortality rates in a further BTS audit published in 2019 although mortality rates across England, at 26%, remain higher than in many other countries.

This project aims to reduce mortality rates to 10% or lower for patients who require acute NIV for Type II Respiratory Failure. This will be achieved through a collaborative approach which implements a regional standardised care bundle.

Watch the Improving NIV care video on Vimeo.

What are we doing?

Working with key stakeholders in the six acute hospitals across the West of England, this project will seek to improve the implementation and usage of a regional standardised NIV 5 care bundle, based on the BTS quality standards, which includes:

Appropriate case selection – NIV is only recommended in acute Type 2 Respiratory Failure where it is proven to be effective.


Treatment Escalation Plan in place – ReSPECT form to be completed with specific reference to suitability for invasive ventilation or NIV as ceiling of treatment.


NIV to be started within 60 minutes of decision to treat.


Inspiratory pressure of 20cmH₂O to be achieved within 60 minutes.


Arterial or capillary blood gas to be repeated within two hours of starting NIV.


In addition, the project will aim to improve staff knowledge of NIV care and adoption and spread methodology alongside supporting a positive patient experience through more effective communication.

Read more in a blog from Dr Rebecca Mason, project Clinical Lead and Respiratory Consultant at the RUH Bath.

How are we doing it?

We aim to reduce mortality rates to 10% or lower for patients who require acute NIV for Type II Respiratory Failure by using quality improvement approaches and tools to ensure that the right support is given to clinicians implementing the bundle. This will include process mapping, developing driver diagrams, PDSA cycles and stakeholder mapping.

We’ll be bringing representatives from the six acute trusts together so best practice and learning can be shared and challenges tackled together. Our design and launch event takes place in December 2022.

Who are we working with?

We will be working with all six acute respiratory departments in the West of England, including:

  • Great Western Hospital
  • Bristol Royal Infirmary, University Hospitals Bristol and Weston
  • North Bristol Trust
  • Royal United Hospitals, Bath
  • Gloucestershire Hospitals Trust
  • Weston General Hospital, University Hospitals Bristol and Weston


Please access our resources:


Quality Improvement

Communications and Engagement

Data Collection

Health inequalities

Evaluation and how to find out more

A project evaluation will be completed by Spring 2024. The evaluation will aim to explore four key themes:

  1. To demonstrate whether mortality rates improve through the implementation of the NIV 5 care bundle.
  2. To understand whether staff confidence and competence improves from being part of the Improving NIV care project.
  3. To learn from patient experience in order to improve NIV care.
  4. To create standardisation of how NIV care is delivered by using a bundle, and to investigate which elements of the bundle work most effectively.

To find out more, please contact healthinnowest.transformation@nhs.net.

Working to improve outcomes for patients with COPD

Improving the outcomes of patients with COPD is a key priority of the NHS England Southwest Respiratory Network. The delivery of this QI project will work to support this priority given that NIV is a core treatment in patients with COPD who are admitted with acute hypercapnic respiratory failure. It has been demonstrated that using NIV appropriately in this patient group improves mortality rates.

COPD Digital CHAMP (Coaching Health App Implementation Partnership)

With the help of NHSX funding, the COPD Digital CHAMP (Coaching Health App Implementation Partnership) project aimed to improve the lives of patients living with COPD within Bristol, North Somerset South Gloucestershire by guiding them to self-manage their condition through the roll-out of the myCOPD app. Read more about the project.