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Screening for sleep disordered breathing among children hospitalized for asthma exacerbation
Neepa Gurbani1,2, Christine L Schuler1,2,3, Daniel Ignatiuk1,2
1Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, USA.
Insights
Sleep disordered breathing (SDB) screening is crucial for children hospitalized with asthma. A quality improvement initiative successfully implemented a screening process, significantly increasing detection rates for this treatable comorbidity.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Quality Improvement in Healthcare
Background:
- Sleep disordered breathing (SDB) is a treatable comorbidity that can worsen asthma.
- Identifying and managing SDB in hospitalized children with asthma is clinically important.
Purpose of the Study:
- To implement and assess a quality improvement (QI) initiative for screening SDB in pediatric patients hospitalized for asthma exacerbation.
- To increase SDB screening rates from 0% to at least 60% within a defined project timeline.
Main Methods:
- A multidisciplinary team utilized QI methodologies to integrate the Michigan pediatric sleep questionnaire (PSQ) into routine care for children aged 2-18 hospitalized with asthma.
- Key interventions included staff education, engagement of respiratory therapists for PSQ completion, and electronic medical record modifications for documentation.
- Progress was monitored using run charts and descriptive statistics.
Main Results:
- The PSQ was completed for 74% of 2067 admitted patients.
- 24% of screened patients (360) had a positive SDB screen, with a mean age of 8.6 years.
- Screening rates exceeded 80% for extended periods, with PSQ completion occurring in ~90% of cases when routine asthma risk screens were done.
Conclusions:
- The implemented SDB screening process was feasible, sustainable, and successfully integrated into asthma care.
- The high rate of positive screens highlights the necessity of evaluating for SDB in pediatric asthma exacerbation hospitalizations.
Background:
Sleep disordered breathing (SDB) may exacerbate asthma and is a treatable comorbidity.
Objective:
To design and implement a screening process for SDB in patients hospitalized for asthma exacerbation using quality improvement (QI) methods. We sought to improve screening for SDB from zero to 60% from July 2019 to December 2020.
Design/Methods:
A multidisciplinary team used QI methods to screen for SDB using the Michigan pediatric sleep questionnaire (PSQ) in patients 2-18 years hospitalized for asthma exacerbation. Key interventions included: pairing the PSQ screen with another element of routine care (the asthma risk factor screen), educating staff and physicians, engaging respiratory therapists to complete the PSQ and document scores, and modifying the electronic medical record (asthma order set and flowsheet for PSQ score documentation). A run chart tracked progress and descriptive statistics were generated.
Results:
There were 2067 patients admitted for asthma exacerbation during this project. The PSQ was completed for 1531 patients (74%) overall. Of screened patients, 360 (24%) had a positive PSQ; the mean age was 8.6 years. Approximately 14 months after the project began, ~90% of children admitted for asthma were being screened; subsequently, >80% of patients were being screened until May 2022. Screening with the PSQ occurred approximately 90% of the time when routine asthma risk screens were completed.
Conclusion:
A screening process for SDB was successfully implemented and appeared feasible and sustainable. The high proportion of positive screens reinforces the importance of evaluating for SDB in the high-risk population of children requiring hospitalization for asthma exacerbation.
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