The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Evans Castor1

Background: In accordance with the newest patient safety goal, initiation of an OSA screening process has been on the agenda of many hospitals across the country. A team approach is necessary in order to provide maximum benefit to the patient population while minimizing the impact on staff.

Edward Hospital assembled a team of specialists in order to provide comprehensive screening services to their patients. Team members were recruited from medical staff, nursing, respiratory care, information systems, risk management, pre-admission testing, and quality excellence. Specialty physicians in the areas of anesthesia, sleep, family practice, and pulmonology were also an integral part of the team.

Based on screening questions and physical assessment, both the medical and surgical patient population received additional OSA-related care when warranted. Anesthesiologists provided interventions for surgical patients, while nursing and RCPs worked together to provide interventions for medical patients. Potential OSA populations were identified by reports generated by information systems based on nursing admission database items. Algorithms and standing order sets were developed in order to provide consistency throughout the hospital. The OSA bundle provided additional stability and effectiveness by bringing together the OSA order set, narcotic screening, oxygen therapy, remote telemonitoring, and CPAP therapy.

As a result of this team approach, Edward hospital was able to identify and treat a significantly larger OSA patient population, eliminate unplanned ICU admissions, decrease OSA-related intubations, and improve patient compliance related to CPAP equipment. In addition, morbidity and mortality was significantly reduced by the elimination of OSA adverse events and OSA cardio-respiratory arrests. Despite identifying a larger OSA population, the CPAP average LOS was decreased by 7% after initiation of the OSA bundle.

An interdisciplinary team approach provides the most effective outcome when implementing a new OSA process. Each team member must know their role, and how their piece fits into the overall care plan. An effective OSA intervention team receives contributions from many areas of the hospital, and results in superior outcomes for both the patient and the hospital.