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Rationalising requests for preoperative sleep studies and postoperative HDU beds: a quality improvement project in
Simon Morris1, Rhodri Jones2, Paramesh Mankunda Puttasiddaiah3
1Department of ENT, Swansea Bay University Health Board, Port Talbot, UK s.morris@doctors.org.uk.
Insights
Implementing the "I'm Sleepy Score" (ISS) and national guidelines reduced paediatric sleep studies and high dependency unit (HDU) bed use. This improved service delivery and offered cost benefits in an ENT unit.
Area of Science:
- Otolaryngology
- Sleep Medicine
- Pediatric Health
Background:
- Sleep disordered breathing encompasses snoring, increased respiratory effort, and obstructive sleep apnea (OSA).
- Increasing demand for pediatric sleep studies and high dependency unit (HDU) beds strained service delivery in an ENT department.
Purpose of the Study:
- To evaluate the impact of implementing the "I'm Sleepy Score" (ISS) and national guidelines on pediatric sleep study requests and HDU bed utilization.
- To assess the effectiveness of a new proforma in streamlining the diagnostic process for sleep disordered breathing in children.
Main Methods:
- A 30-month retrospective and prospective review of pediatric sleep study requests in a tertiary ENT department.
- Introduction of a "Sleep Study" proforma incorporating the ISS and ENT-UK national guidelines.
- Data collection included study indications, results, patient outcomes, operative details, and HDU bed occupancy.
Main Results:
- Initial retrospective review (198 studies) showed 62% had no evidence of OSA.
- Post-intervention prospective review (60 patients) revealed 62% with OSA evidence.
- The intervention reduced sleep study requests by over 50% and HDU bed occupancy by 50%.
Conclusions:
- The ISS and ENT-UK guidelines effectively reduced unnecessary sleep studies and rationalized HDU bed requests.
- This intervention led to a more prudent elective pediatric ENT service with associated cost savings.
- Standardized protocols improve diagnostic accuracy and resource allocation for pediatric sleep disordered breathing.
Background:
Sleep disordered breathing represents a spectrum of upper airway obstruction including snoring, increased respiratory effort and obstructive sleep apnoea. An increasing demand for paediatric preoperative sleep studies and postoperative high dependency unit (HDU) beds was having a significant impact on service delivery at this ear, nose and throat (ENT) unit.
Methods:
Retrospective and prospective review of all paediatric sleep study requests over a 30-month period in a single tertiary ENT department. Data were collected on indication for and result of sleep study, patient outcome, operative details and HDU bed occupancy. During the study period, a 'Sleep Study' proforma was introduced which incorporated the 'I'm Sleepy Score' (ISS) and ENT-UK national guidelines.
Results:
Retrospective review included 198 sleep studies, of which 62% (n=118) showed no evidence of obstructive sleep apnoea (OSA). There was little consistency in patients' sleep study results and need for monitoring on HDU following adenotonsillectomy. Prospective review following intervention included 60 patients, of which 62% (n=37) showed evidence of OSA. The mean ISS in this cohort was 4.7. Only those with moderate-to-severe OSA or with relevant risk factors underwent overnight HDU observation. The number of sleep study requests fell by >50%; from 11 per month to 5 per month. The total HDU bed occupancy was reduced by 50% following intervention (from n=18 to n=9).
Conclusion:
The use of the ISS and incorporation of ENTUK's recommendations has reduced the number of negative sleep studies being requested and has rationalised the number of paediatric HDU bed requests being made. This has helped provide a prudent elective paediatric ENT service in this unit with corresponding cost benefits.
