Interprofessional Evidence-Based Care of Hospitalized Patients with and at Risk for Sleep Apnea Improves Care Quality

Purpose:
The project goal was to enhance healthcare outcomes for hospitalized patients with and at-risk for sleep apnea (SA) by increasing the ability of hospital nurses to asses for known SA, identify SA risk, and design appropriate nursing care management using an inter-professional care guideline.

Background/Significance:
Hospital prevalence of SA is estimated to be 80%, yet only 6.8% are reported, and 5.8% of patients on home therapy continue treatment during hospitalization. Adverse hospital outcomes including increased length of stay, cardio-respiratory failure, and death are associated with untreated SA. Validated SA screening tools and care guidelines are available but have not been widely adopted. Educating nurses on SA assessment, screening, and evidence-based care guidelines can improve patient outcomes.

Methods:
An educational intervention to the care team of a monitored care unit at a community hospital consisted of an a)overview of SA diagnosis, treatment, impact on patients' health, and hospitalized patient outcomes, b)rationale for screening for SA diagnosis and continued hospital use of home PAP, c) use of the STOP-Bang questionnaire, and d) use of an inter-professional evidence-based SA care management guideline. The Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) assessment was administered to the care team pre/post intervention and 30-days post implementation of the care guideline. Patient length of stay, unplanned transfer, death, and 30-day readmission were monitored for 90-days.

Results:
The intervention was attended by 41 care team members, 3o completed the Pre/Post OSAKA. Paired t-test showed significant increase in OSAKA scores post educational intervention for knowledge, attitude and confidence that was retained 30-days post implementation of the care guideline. One-way ANOVA showed no correlation between staff type, years of practice or education level and OSAKA scores. Of the 104 patients screened, 67.8% were identified as high SA risk, (21% with known SA), and 32% low SA risk .  PAP therapy was received by 100% of those identified on home PAP compared to 5.5% prior to the intervention.  The ALOS was shortest for the SA group (2.6 days), compared to 3.28 days (high risk) and 2.74 days (low risk).  The 30-day readmission rate for the SA group was 0%, high risk/10%, and low risk 14%. No unplanned transfers to higher acuity of care or death occurred during the 90-day pilot.  Identification of known SA pre-intervention was 5.5% and 21% post. 

Conclusions and Implications for Practice:
Implementing and sustaining quality improvement changes designed to improve SA patient outcomes will require inter-professional collaboration led by the hospital nurse. Education provides a means to bridge the current care gap and enhance healthcare outcomes in this vulnerable patient population.  National and local policy directing the care of this vulnerable population is recommended.