P213 Implementation of a novel obstructive sleep apnoea pathway. (15th November 2017)

• Record Type: Journal Article
• Authors: Picton-Turbervill, L; Butcher, J; Neville, S; Heaps, C; Jullian, H; Gunatilake, S
• Is Part Of: Thorax. Volume 72(2017)Supplement 3
• Page Start: A198
• Page End: A200
• Publication Date: 2017-11-15
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2017-210983.355
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction: Obstructive Sleep Apnoea (OSA) is a common but under-diagnosed form of sleep disordered breathing. It causes debilitating symptoms and significant morbidity. The gold standard treatment for moderate to severe OSA is continuous positive airway pressure (CPAP) accompanied by lifestyle advice and weight loss. It is estimated that between 2%–4% of middle aged men and 0.5%–1% of women are affected and this service receives around 200 referrals per year consistent with national predictions. 1 Staffing remains unchanged since service set up in 2007 with two consultant sessions and one full time nurse specialist (CNS) however due to ever increasing demand the existing service was exhibiting unacceptably long referral to treatment times (RTT). Method: 202 referrals from April 2016 to end of April 2017 were retrospectively reviewed. 101 patients were seen according to the established pathway consisting of initial clinic consultation with onward investigation and management. A novel OSA pathway was initiated in February 2017 and the next 101 consecutive patients were reviewed. All patients were offered a group session for respiratory polygraphy with the CNS. Patients completed a short symptom questionnaire and Epworth Sleepiness Score. These measures allowed the Consultant clinic template to increase capacity from 6 to 9 patients (50% increase). Furthermore if CPAP is indicated set up is on the same day now as the CNS attends clinic too. Results: This new pathway improved RTT from a median of 121 days to 35 days. There was also significant improvement in diagnostic clinic outcomes from 18% to 88% (figure 1 ) Conclusion: Implementation of this new OSA pathway incorporating a symptom questionnaire and early diagnostic testing has enabled a significant increase in clinic capacity achieving an improvement in RTT of 70%. Earlier treatment commencement will also lead to quicker resolution of day time somnolence limiting the time during which patients must abstain from driving and the resulting negative impact on their livelihood and lifestyle. At a time when healthcare budgets demand more for less we have demonstrated the efficacy of this new pathway. Reference: https://www.brit-thoracic.org.uk/document-library/clinical-information/sleep-apnoea/impress-service-specification-for-investigation-and-treatment-of-osas/