The Health Information and Quality Authority (HIQA) has today published a health technology assessment (HTA) on domiciliary (at-home) invasive ventilation for adults with severe spinal cord injuries. The report was requested by the Health Service Executive (HSE) in conjunction with the National Rehabilitation Hospital (NRH). It was conducted to inform the national delivery of care for adults with spinal cord injuries who require permanent invasive mechanical ventilation and in whom discharge home is deemed clinically appropriate. 

Individuals with high spinal cord injuries have complex healthcare needs due to complications such as the complete paralysis of all four limbs and torso (tetraplegia) and respiratory failure. In order to breathe, a small number of these individuals will have a lifelong dependency on invasive mechanical ventilation via tracheostomy. Currently, an estimated five to ten adults with spinal cord injuries in Ireland receive invasive mechanical ventilation at home. While domiciliary ventilation is currently standard practice in Ireland for these patients, there are many challenges involved in their safe discharge home. As a result, they often remain in hospital for a prolonged period of time. This significantly impacts the quality of life of patients and their families and can place a strain on health service provision. 



HIQA reviewed guidelines for domiciliary ventilation from other countries. Guidelines were identified from Australia, Canada, Germany, Italy, New Zealand, Poland, Switzerland, the Netherlands, the UK, and the US. These guidelines gave advice about aspects such as discharging a patient home from the hospital, looking after the patient when they are at home, and the equipment and staff that would be needed. The review highlighted key areas of importance for delivering a domiciliary ventilation service such as ensuring severe spinal cord injury patients had: 24/7 care provided by trained staff, specialised equipment and consumables, an adapted house and vehicle, and access to information and supports.



HIQA estimated the total five-year budget impact for the provision of domiciliary ventilation care to be approximately €3.4 million per patient. While it is unclear whether care at home would cost more or less than hospital care for these patients, it was noted that domiciliary ventilation may alleviate some of the substantial challenges currently experienced by patients and families, and would free up intensive care unit beds.



Dr Conor Teljeur, HIQA's Chief Scientist, said, "Spinal cord injuries can have a profound impact on a person’s life. The results of this assessment support the development of a national clinical pathway for this patient cohort that extends into the community. This pathway should have an overarching clinical governance framework. It would also benefit from a national training and support role, and to be funded through a centralised budget."



To access the full HTA report and learn more, please click on the llink at the top of the page

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For further information please contact:

Marty Whelan, Head of Communications and Stakeholder Engagement 085 805 5202 / mwhelan@hiqa.ie



Notes to the editor:

• The Health Information and Quality Authority (HIQA) has today published the following document: 
  • Health technology assessment: Domiciliary invasive ventilation for adults with spinal cord injuries
• The protocol for this HTA was previously published by HIQA on 21 February 2023 and can be found here.
• An integrated care pathway for patients with spinal cord injuries has been developed in Ireland by the National Clinical Programme for Rehabilitation Medicine, in line with its model of care. This care pathway extends from pre-hospital care to discharge and lifelong care. The current integrated care pathway for the management of spinal cord injury can be found here.