16 Mar 2023

Model of Care for Specialised Weaning Units

Supporting a step-down from Critical Care: BTS and ICS release a Model of Care for Specialised Weaning Units.

The Intensive Care Society and the British Thoracic Society have collaborated to produce a Model of Care for Specialised Weaning Units (SWU). This Model of Care document provides guidance on the standards of care, resourcing, and infrastructure for this enhanced care area.

A SWU enables dedicated, multi-professional care to be delivered to patients who are invasively ventilated but no longer require the level of organ support that they have received from critical care units. Patients transitioning to less invasive methods of respiratory support are supported to do so in SWUs, progressing to non-invasive ventilation (NIV) or a tracheostomy to be managed in the community.  The primary focus of a SWU is to deliver high quality patient care by a multi-professional team with experience in patients with complex ventilatory requirements.  However, enhanced care in general and SWUs also have a role in releasing capacity in critical care units.

We are pleased to see this guidance on developing Specialised Weaning Units (SWU) published. We believe it will be an invaluable resource for those teams within our hospitals and trusts looking to establish an entirely new or build up an existing SWU. It has relied on multi-professional expertise which underpins the very teams who deliver specialised weaning.

Dr Stephen Webb, Immediate Past President

Intensive Care Society

The key guidance covers five main areas, the patient cohort, governance and safety, research and quality improvement, workforce, and patient pathways.

At a high-level, the document looks at which patients SWUs are appropriate for and includes examples of referral criteria, treatment, management, and discharge procedures. It outlines what the successful management and structure of SWUs should look like, and associated safety measures such as infection control and staffing.

Development of SWUs offers a unique opportunity to provide specialist, high quality care from an expert multi-professional team, and will also free up critical care capacity to treat acutely unwell patients and support elective surgery.  The document is a collaboration between the British Thoracic Society and the Intensive Care Society and draws on the expertise and experience of the full multi-professional team who will be required to care for patients on SWUs.

Dr Ben Messer, Lead Author

British Thoracic Society

It has been shown internationally that there are multi-professional skills required to achieve successful weaning, distinct from those available in a more general critical care unit. All members of the multi-disciplinary respiratory team including the Allied Health Professions and pharmacists should all have significant input into the SWU patient journey.

The British Thoracic Society is delighted to launch this Model of Care document, developed in close collaboration with the Intensive Care Society. The patients involved face huge challenges and this guidance aims to support the delivery of high standard care to facilitate optimal recovery in as timely and efficient way as possible. This requires highly skilled professionals working in a safe and structured environment who are constantly endeavouring to improve care quality. We expect this guidance to contribute significantly to this delivery.

Dr Paul Walker, Chair,

British Thoracic Society

A clear conclusion that can be drawn from the Model of Care document is that putting patients and their families at the forefront of care is vital to successful SWUs. The guidance provided reflects this and is able to be adapted for local use.

The Model of Care for Specialised Weaning Units document is available here.