0919 EMR-Integrated Clinical Pathway Improves Familiarity with Obesity Hypoventilation Syndrome Among Inpatient Clinicians

Abstract

Abstract Introduction Obesity hypoventilation syndrome (OHS) is an underrecognized chronic respiratory condition characterized by obesity (BMI > 30kg/m2) and hypoventilation (PaCO2 > 45mmHg) in the absence of other causes of hypoventilation. In OHS, obesity causes mass loading on the respiratory system, leading to CO2 retention, diminished ventilatory response, progressive hypoxia/hypercapnia, and eventual cardiopulmonary arrest. OHS is typically diagnosed while inpatient, wherein 18-month mortality approaches 23%. Non-invasive ventilation (NIV) improves OHS symptoms & prognosis which subsequently decreases healthcare utilization and mortality. With the proper tools and training, inpatient providers can facilitate accurate diagnosis and prompt treatment of OHS. Our team developed an EMR-integrated clinical pathway to increase recognition and facilitate treatment of OHS in hospitalized patients on the general medicine service. Methods The OHS Pathway was implemented among a large group of hospitalists at a tertiary academic medical center. A multi-disciplinary team of physicians, respiratory therapists, and care coordinators designed the pathway structure and content. Prior to integrating the OHS pathway into the EMR, hospitalists were surveyed to assess existing knowledge and experiences caring for patients with OHS. Hospitalists then participated in an educational series on OHS with orientation to the pathway. 12-months into the intervention, hospitalists were re-surveyed. Results Survey data analysis revealed that providers were significantly more familiar with the diagnostic criteria for OHS after (n=40) the introduction of the clinical pathway rather than before the introduction (n=24) of the pathway (t (62) = 2.88, p = .0027). Subjective success rates for prescribing NIV to patients upon discharge did not significantly improve Conclusion OHS diagnosed in the inpatient setting carries significant morbidity and mortality. Proper detection and prompt treatment of OHS are essential to improving the care and prognosis of this high-risk population. We demonstrate that our multi-disciplinary based, EMR-integrated clinical pathway increased provider familiarity with the diagnostic criteria for OHS. While treatment success did not significantly improve, numerous systems factors were at play, and further investigations are needed to address access to treatment. Support (if any)