The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

IMPLEMENTING AN EVIDENCE-BASED, OUTCOMES DRIVEN, INTERDISCIPLINARY TEAM IN A RURAL, CRITICAL ACCESS HOSPITAL: THE IMPACT OF PRE-OPERATIVE OBSTRUCTIVE SLEEP APNEA (OSA) ASSESSMENTS

Kimberly J. Bennion1, Carri Aguiar1, Julie Ballard2, Ezra Segura1, Michele Ludlow1, Michelle Colledge1, Jenny Chambers1; 1Heber Valley Respiratory Care, Intermountain Healthcare, Heber, UT; 2System Improvement, Primary Children’s Medical Center, Intermountain Healthcare, Salt Lake City, UT

Introduction: Heber Valley Medical Center is a 19-bed critical access hospital of the Intermountain Healthcare Corporation.With limited nursing resources, administrative leadership piloted the use of respiratory therapists (RT) to perform a detailed pre-surgical assessment. We obtained a pre-surgical OSA assessment guideline from our sister hospital1 & obtained medical executive committee approval for implementation. The guideline included a Modified Berlin Score(MBS. The MBS is a scoring tool utilized to determine a patient’s(pt)risk of OSA post-anesthesia. The score assigns points for positive responses to questions about snoring,pauses in breathing,sleepiness in the morning/during the day&assigns points based on body mass index.Scores > 25 were considered a predictor of possible post-operative airway compromise & need for interventions such as continuous positive airway pressure(CPAP)or bi-level ventilation(BLV). RTs received pt referrals for assessments triggered by a positive response to the question of snoring.The day of surgery,RT gathered an initial assessment,detailed history, existing co-morbidities & general medication use. Nurses&physicians were notified of pts scoring >25. We sought to identify what if any impact an interdisciplinary team using a second more detailed assessment&MBS might have on the outcomes of post-operative pts. Method:Comparison data of all 2008 surgical pts who received the second assessment were identified via the RT OSA assessment database which was kept concurrently throughout 2008. Initial inclusion criteria were pts scheduled for surgery who received an OSA by RT.Eighty-one pts were identified who met the criteria,none were excluded. Results:Outcomes are reported in Table One.Discussion:It is our impression that the MBS is a reliable screening tool for identifying possible airway post-operative complications requiring CPAP/BLV in pts who have undiagnosed but suspected OSA since 48% of those pts screened did require CPAP/BLV. We have used the MBS to proactively assemble equipment,notify staff, and improve the continuum of care from the operating room, to the recovery room & the inpatient setting. An Executive Summary of our findings was reported to administration & the interdisciplinary Quality Workgroup for process refinement/improvement. 1Utah Valley Regional Medical Center, Provo, Utah (Karl Ludwig RRT & Douglas Ross MD). Modified Berlin Questionaire used & modified with permission of Kingman P. Strohl MD. Sponsored Research - None

*Required defined as: Pulse oximetry desaturation unresponsive to oxygen via nasal cannula &/or simple mask &/or documented airway obstruction (ie: snoring, apnea, “not responding to sternal rub”)

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