Presentation Details
| Closing the Diagnostic Gap: A Same day Home Sleep Study–Driven Workflow to Optimize Obstructive Sleep Apnea in the Preoperative Setting Abhijai Singh1, Kurt Pfeifer1, Rose Franco1, Angela Selzer2. 1Medical College of Wisconsin, Milwaukee, WI, USA.2University of Colorado, Denver, CO, USA |
Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is a common and underrecognized perioperative risk factor that increases the likelihood of postoperative complications, unplanned admissions, and resource utilization. Traditional diagnostic and therapeutic pathways rely on in-lab polysomnography and consultation with sleep medicine can lead to long delays. This method is slow, costly, and poorly aligned with preoperative timelines. To increase early identification and optimization of OSA when appropriate, we piloted a same-day home sleep testing (HST)–driven pathway at a large academic medical center.
PURPOSE: A multidisciplinary team spanning sleep lab, pulmonology, and preoperative clinic was established for evaluation of patients at-risk for OSA at a high-volume preoperative clinic in a large, tertiary care academic hospital system. Elevated-risk patients (STOP-Bang ≥3) were referred for expedited HST through this pilot. Enhancements were implemented by expanding existing processes rather than creating new workflows, thus minimizing provider and nurse burden. Process metrics included HST completion rate, time-to-diagnosis, PAP initiation rate, surgical delays, and patient satisfaction (5-point scale).
RESULTS: Among 41 patients screened, STOP-Bang averaged 5.5, with 87.8% rated high-risk with STOP-Bang ≥5. HST completion was 97.5%, and 95% of completed studies resulted in an OSA diagnosis. Severe OSA (AHI ≥30) accounted for 25% of diagnoses. Time from preoperative visit to HST completion averaged 3.2 days, while diagnosis was established within an average of 5.6 days. One-third of eligible patients-initiated PAP therapy preoperatively. Four surgeries (9.7%) were delayed due to safety concerns, and three procedures were escalated from outpatient surgery to overnight observation status based upon their risk for sleep apnea-associated complications. Patient satisfaction was high (Mean 4.3/5), with feedback emphasizing clarity and convenience.
CONCLUSIONS: A streamlined HST-based workflow within a preoperative clinic is feasible and effective for perioperative optimization. This innovation achieved high diagnostic yield, rapid turnaround times, and meaningful risk mitigation while maintaining excellent patient satisfaction. These results support larger-scale implementation into value-based perioperative care models.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: A multidisciplinary team spanning sleep lab, pulmonology, and preoperative clinic was established for evaluation of patients at-risk for OSA at a high-volume preoperative clinic in a large, tertiary care academic hospital system. Elevated-risk patients (STOP-Bang ≥3) were referred for expedited HST through this pilot. Enhancements were implemented by expanding existing processes rather than creating new workflows, thus minimizing provider and nurse burden. Process metrics included HST completion rate, time-to-diagnosis, PAP initiation rate, surgical delays, and patient satisfaction (5-point scale).
RESULTS: Among 41 patients screened, STOP-Bang averaged 5.5, with 87.8% rated high-risk with STOP-Bang ≥5. HST completion was 97.5%, and 95% of completed studies resulted in an OSA diagnosis. Severe OSA (AHI ≥30) accounted for 25% of diagnoses. Time from preoperative visit to HST completion averaged 3.2 days, while diagnosis was established within an average of 5.6 days. One-third of eligible patients-initiated PAP therapy preoperatively. Four surgeries (9.7%) were delayed due to safety concerns, and three procedures were escalated from outpatient surgery to overnight observation status based upon their risk for sleep apnea-associated complications. Patient satisfaction was high (Mean 4.3/5), with feedback emphasizing clarity and convenience.
CONCLUSIONS: A streamlined HST-based workflow within a preoperative clinic is feasible and effective for perioperative optimization. This innovation achieved high diagnostic yield, rapid turnaround times, and meaningful risk mitigation while maintaining excellent patient satisfaction. These results support larger-scale implementation into value-based perioperative care models.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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