Implementation of a Systematic Approach to Screening for OSA in a Surgical Navigation Center (SNC)

Abstract

SESSION TITLE: Sleep 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: OSA is a common problem that often escapes diagnosis. Up to 90% of surgeons and 70% of anesthesiologists do not identify patients at risk for OSA during preoperative evaluations. Patients with OSA are far more likely to experience postoperative complications including re-intubation, atelectasis, pneumonia, and respiratory failure, which often result in longer length of stay. The use of sleep apnea specific questionnaires in Preoperative Assessment Clinic (PAC) settings can identify patients at risk for sleep apnea, but little is known regarding implementation of a systematic approach to screening, diagnosing and treating OSA in the perioperative population. METHODS: In our large tertiary care facility, a pilot study was conducted in 920 prospective PAC patients. 581 were screened and followed perioperatively. 2.6% (17 patients of the 581 screened) sustained a major hospital event (MHE). From the patients’ responses in combination with risk factors identified from MHE, a 9 item questionnaire was derived: DOISNORE50. A score ≥6 has a positive predictive value for detecting OSA of 84%. Patients were categorized as low risk (score <3), at risk (score 3 to 5), or high risk (score >5) for OSA. As part of a quality improvement project, DOISNORE50 was introduced in the SNC. High risk patients were referred for same day sleep consultation. From February 2016 to January 2017, data were collected on patients seen in the SNC, number screened, screening score, number referred for PAC visits, and number receiving same day sleep consultation. All patients screened during this period were included in a Sleep Registry. RESULTS: During the 12 month observation period, 20,200 patients were seen in the SNC. Of these, 19,796 (98%) were screened for OSA. 40% (7,918) were considered at risk and 17% (3,365) were considered high risk for OSA. 920 patients (5%) were high risk for OSA and referred to the PAC. Of these, 85% were evaluated by a sleep trained advanced practice provider on the same day and received recommendations for perioperative PAP therapy and appropriate follow up. All patients scoring >3 received an “OSA precautions” wristband on the day of surgery. Additionally, all patients who were at risk or high risk, had known OSA, were already on CPAP or had a positive sleep study (32,729 patients) were included in a Sleep Registry. CONCLUSIONS: We demonstrate that the implementation of a sleep screening process and same day consultation by a sleep provider for high-risk patients within the SNC/PAC is feasible. This systematic approach and the institution of a sleep registry provide a comprehensive model of a “closed loop” approach to sleep care within the pre-surgical home. Encompassing both known and at risk populations, the registry can estimate the burden of this disease on the health system. CLINICAL IMPLICATIONS: Early identification of at risk and high risk patients using the DOISNORE50 questionnaire and same day consultation allows for early intervention in the perioperative period and is anticipated to reduce major hospital events. DISCLOSURE: The following authors have nothing to disclose: Sarah Ellen Stephens, Zeeshan Ahmad, Kelly Younger, Kristina Foard, Doug Case, Daniel Forest, Andrew Namen, Sandhya Kumar, Stephen Peters, Edward Haponik No Product/Research Disclosure Information