P55 The implementation of a Computer Guided Consultation (Clinical decision support system) for the assessment of suspected Obstructive Sleep Apnoea in a large sleep service: a twelve month analysis. (11th November 2022)

• Record Type: Journal Article
• Authors: Keane, R; Qureshi, T; Mir, M; Reed, L; England, P; Mcknight, E; Osborne, M; Angus, RM; Chakrabarti, B; Craig, SE
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A111
• Page End: A112
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.191
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Following pandemic disruptions to sleep services and an increase in obstructive sleep apnoea referrals, we have introduced a novel clinical pathway central to which lies a comprehensive clinical decision support system (CDSS; SleepHealth Solutions Ltd) including a computer-guided consultation for suspected OSA. Previously, every referral letter and sleep study would be reviewed virtually by a consultant followed by a treatment decision, consultant appointment or discharge. Now, each patient undergoes a computer-guided consultation (termed 'Initial Review'), a sleep study if indicated by the CDSS which then integrates the data generating a 'final diagnosis' and prompts a management plan whilst alerting for 'high risk' patients e.g. sleepy drivers, potential hypoventilation. Sleep physiologists review each completed 'Initial Review' consultation and then proceed to CPAP or request consultant virtual review/clinic appointment supported by the CDSS. Methods: Data from patients attending the Sleep Service with suspected sleep apnoea from 1 March 2022– 10 May 2022 were extracted from the CDSS including history, demographics, diagnosis, investigation and treatment. Results: 1591 patients (mean age 50 (SD 8.76) years, 56% male, BMI 35.2 (SD 14.4), AHI 18.02 (SD 20.1) Epworth Sleep Score 10.4 (SD 5.8)) underwent an 'Initial Review' consultation. 83.8% of patients were diagnosed by the CDSS with obstructive sleep apnoea or possible sleep apnoea, 2.2% with central apnoea and 0.6% with obesity hypoventilation syndrome. 12.6% of patients were not diagnosed with a sleep condition. 52.5% started CPAP, 13.5% underwent further sleep studies, 11.9% were discharged and 4.15% were reviewed further by a physiologist. 6.5% of those patients entering the CDSS pathway required a virtual consultant review compared to over 85% prior to the implementation of the new pathway. 7.2% of patients entering the CDSS pathway required a consultant outpatient clinic appointment compared to 82% historically. Conclusion: The implementation of a clinical pathway using the CDSS improves efficiency, greatly reducing the need for Consultant review while delivering high quality consistent consultations, and maintains patient safety. This releases Consultant resource enabling assessment of complex and high-risk sleep patients. Please refer to page A214 for declarations of interest related to this abstract.