Ward-Based High-Flow Nasal Cannula Led by the Medical Emergency Team: A Pragmatic Model for Resource Stewardship

Abstract

High-flow nasal cannula (HFNC) for acute hypoxemic respiratory failure is typically restricted to ICUs. We evaluated a ward-based, medical emergency team (MET)-supervised HFNC protocol (flow ≤ 40 L/min, Fio2 ≤ 0.40) with 2-/4-/8-hour nursing and respiratory therapist reassessments. Among 82 ward HFNC initiations (2021-2024), 38 (46%) required immediate ICU transfer (IMT) and 44 (54%) were Ward-Managed After MET (WMAM). Of WMAM patients, 18 transferred to ICU within 48 hours, and 26 remained on ward. WMAM patients accrued a median 1.46 ICU bed-days saved (interquartile range, 0.73-2.67); bootstrapped mean 1.63 (95% CI, 1.32-1.94), equivalent to 163 ICU days-saved per 100 initiations. Intubation (30% vs. 42%; p = 0.24) and 28-day mortality (32% vs. 39%; p = 0.47) were similar between WMAM and IMT; adjusted analyses were directionally consistent. Using an estimated $5,000 per ICU-day, cost avoidance was ≈$815,000 per 100 initiations. This MET-supervised model appears feasible, resource-sparing, and without apparent safety signal.