Presentation Details
| Implementation of a Rural OSA Screening and Sleep Study Pathway in a Pre-Anesthesia Clinic Margeson Megan, Kendall Parks, Amy Mouat-Hunter. Bozeman Health, Bozeman, MT, USA |
Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is common, underdiagnosed, and associated with increased perioperative respiratory risk. Early identification is especially challenging in rural hospitals with limited sleep-medicine resources. To improve safety, the Bozeman Health Pre-Anesthesia Clinic (PAC) implemented a structured OSA screening and expedited sleep-study pathway.
PURPOSE: All PAC patients received STOP-Bang screening. A STOP-Bang ≥5 or concerning symptom clusters triggered referral for rapid home sleep apnea testing (HSAT) through an expedited pathway with sleep medicine. PAC clinicians reviewed results promptly, conducted formal perioperative risk discussions, and incorporated optimization steps (CPAP initiation when feasible, opioid-sparing strategies, postoperative monitoring plans). Standardized inpatient and outpatient postoperative OSA protocols were created to ensure consistent management. The pathway was intentionally designed to fit the resources of a rural health system.
RESULTS: Implementation led to earlier OSA risk recognition, timely HSAT access, and clearer perioperative planning. Clinicians reported improved communication, more consistent decision-making, and fewer day-of-surgery surprises. Patients valued the streamlined process and enhanced understanding of their risks. The model proved feasible and effective within a rural hospital. We have data on our postoperative respiratory failure, which is improved and much below the national average.
CONCLUSIONS: A structured OSA screening and expedited HSAT pathway can be successfully implemented in a rural pre-anesthesia clinic. This 18-month, multidisciplinary effort demonstrates a scalable, resource-conscious model for improving perioperative safety and standardizing OSA management in small- to mid-sized hospitals.
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: All PAC patients received STOP-Bang screening. A STOP-Bang ≥5 or concerning symptom clusters triggered referral for rapid home sleep apnea testing (HSAT) through an expedited pathway with sleep medicine. PAC clinicians reviewed results promptly, conducted formal perioperative risk discussions, and incorporated optimization steps (CPAP initiation when feasible, opioid-sparing strategies, postoperative monitoring plans). Standardized inpatient and outpatient postoperative OSA protocols were created to ensure consistent management. The pathway was intentionally designed to fit the resources of a rural health system.
RESULTS: Implementation led to earlier OSA risk recognition, timely HSAT access, and clearer perioperative planning. Clinicians reported improved communication, more consistent decision-making, and fewer day-of-surgery surprises. Patients valued the streamlined process and enhanced understanding of their risks. The model proved feasible and effective within a rural hospital. We have data on our postoperative respiratory failure, which is improved and much below the national average.
CONCLUSIONS: A structured OSA screening and expedited HSAT pathway can be successfully implemented in a rural pre-anesthesia clinic. This 18-month, multidisciplinary effort demonstrates a scalable, resource-conscious model for improving perioperative safety and standardizing OSA management in small- to mid-sized hospitals.
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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