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UK-RES-2100547 March 2021.
Everyone's Talking About

The USPs of the new guidance for Respiratory Support Units


The British Thoracic Society (BTS) and the Intensive Care Society (ICS) published guidance for the establishment and operation of Respiratory Support Units (RSU) across the UK, and set out standards for clinicians and service providers.[1] [2]

The guidance is a welcome framework for quality assurance and to enhance quality of care available for patients with complex respiratory conditions who require the greatest amount of specialist care.[3]

Pooling expertise to deliver effective care, particularly to the growing population of patients with complex health needs is important for the delivery of specialist care and its sustainability.

Lessons learnt from multi-disciplinary collaborations in the management of the COVID-19 pandemic provide a clear rationale for the application of collaborative approaches within respiratory care.[1]

A Respiratory Support Unit (RSU) is an area where enhanced respiratory care is delivered at the interface of respiratory and critical care.[4] Here patients can be monitored and treated by highly specialised multi- professional teams.[4]

There are many unique characteristics of the BTS/ICS guide on the Development and Implementation of Respiratory Support Units, particularly the inclusion of a step-by-step practical guidance that covers governance, service model, workforce and patient pathways in a format that is clear, simple to understand reading for a broad audience.[4]

The guide also provides a logistical plan to support stakeholders and key decision makers to ensure the provision of an appropriate service to meet the unique and diverse needs of respiratory patients with complex needs.[4]

The guide addresses the specific role each profession has to play within the multi-disciplinary team (MDT) approach for a Respiratory Support Unit.[4]

For example, the workforce detail for nursing staff not only includes recommendations on minimum staff: patient ratio based on patient acuity but extends to detail requirements for clinical competencies including, designated training funding and protected time for the attainment of respiratory competencies to care for the patients on the unit.[4]

This is a decisive address of the challenges of matching available training resource allocation and specific job roles.

The BTS/ICS guide also outlines the different levels of expertise available within the specialist multidisciplinary workforce and how different experts, including nurses, physiotherapists and medical colleagues can work collaboratively to support the delivery of a seamless high level of care with expertise to cover all aspects of specialist respiratory care on a 24-hour, seven day a week basis.[4]

This is a true endorsement of the vital role the workforce plays within the MDT and much-needed recognition of the contribution of nurses and allied health professions to the specialist respiratory workforce.

As well as providing a clear plan for governance, supervision and mentorship integral to the sustainability of the wider multidisciplinary workforce, this level of detail could also provide an avenue for the exploration of potential interprofessional working, interprofessional education and/or development within the units.

The potential gains for such an approach could include optimising opportunities to develop innovative care and improving patient care, together with improving/maintaining staff morale and motivation through job satisfaction.

Patients with complex respiratory disease have in the past presented a challenge to clinical services with regards to the availability of expertise and resources.

The BTS/ICS guide on the Development and Implementation of Respiratory Support Units offers a framework to develop such services locally taking into consideration the number of patients and available facilities.[4]

Hospitals that had established RSUs had lower mortality rates during the pandemic and the legacy of their success has initiated the recommendation that they should feature as a standard service across the NHS.[5]

Any advice given and opinions expressed in this article are those of the author and do not reflect the view of Chiesi Limited (Chiesi).  All content in this article is for informational and educational purposes only.  Although Chiesi strives to always provide accurate information, it is not responsible for and does not verify for accuracy any of the information contained within.

[1] Introducing Respiratory Support Units in all NHS hospitals will transform respiratory care. British Thoracic Society. 2021. Available at: units-in-all-nhs-hospitals-will-transform-respiratory-care/

[2] Respiratory Support Unity. British Thoracic Society. 2021. care/respiratory-support-units/

[3] Every UK hospital should have a respiratory support unit, say doctors. British Medical Journal. 2021. Available at:

[4] Respiratory Support Units: Guidance on development and implementation. British Thoracic Society 2021. Available at: units/respiratory-support-units-guidance-on-development-and-implementation/

[5] NHS England and NHS Improvement. Respiratory Medicine GIRFT Programme National Specialty Report 2021. Available at


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UK-RES-2102421 December 2021