2007 OPEN FORUM Abstracts
30 DAYS OF POST SURGICAL OSA IDENTIFICATION AND TREATMENT.
M. J. MacAulay1, M. Bramlett1
Background: Sentinel and near sentinel events involving patients with undiagnosed sleep apnea in our peri-operative patients caused us to reevaluate how these patients were recovered and treated in their post operative care. Our goal was to provide protocol driven respiratory care for suspected sleep apnea patients immediately after surgery with continued CPAP treatment after hospital discharge. To help initiate this protocol, the St. Joseph Hospital Foundation in Bellingham provided a grant to cover the cost of circuits and masks.
Method: Before surgery, patients are evaluated with the Berlin Questionnaire for possible OSA. After surgery, patients determined by the anesthesiologist to have suspected OSA are admitted to a unit where central monitoring of continuous oximetry with alarms to nursing pagers is possible. These patients are placed on room air and if they desaturate to less than 89%, they are placed on Autotitrating CPAP (APAP). The APAP and continuous oximeters are downloaded in the morning and reviewed by a physician. Normally when patients are discharged, most insurance companies will not pay for any CPAP therapy until the patient has completed a PSG study. At St Joseph Hospital we have collaborated with three home care companies to provide free APAP units for 30 days or until a PSG study has been completed. These companies provide APAP units, follow up visits, and masks with circuits. After the PSG, the insurance companies begin to reimburse the home care companies.
Results: From January 2006 to January 2007, 116 patients left St Joseph Hospital with APAP units. 58 patients completed PSG studies, the rest elected not to have a PSG study. 54 of the 58 patients who completed the PSG were positive for OSA and required CPAP or BiPAP.
Conclusion: We have not observed any near sentential events since inception of this program. A large number of undiagnosed OSA patients were identified and treated. Upon evaluation of this program, it was found that the compliance of some of the patients discharged with CPAP units was disappointing: they did not keep their scheduled PSG study appointments. Now patients with suspected mild OSA are not being discharged with APAP units; instead they are scheduled for a consultation with a sleep physician for further evaluation.