Automated notification of suspected obstructive sleep apnea patients to the perioperative respiratory therapist: a pilot study.
BACKGROUND
Obstructive sleep apnea (OSA) increases the risk of central and obstructive apneas after anesthesia, but the vast majority of patients with OSA are undiagnosed preoperatively. Current guidelines promote the use of postoperative continuous positive airway pressure (CPAP) in patients with OSA. Owing to the complex postoperative requirements of these patients, respiratory therapists (RTs) could substantially improve these patients' clinical management in the immediate postoperative period. We describe a system that identifies patients with suspected or documented OSA and automatically alerts the perioperative RT.


METHODS
Patients who presented for surgery were preoperatively assessed, and if the patient had a diagnosis of OSA or OSA risk factors, the perioperative RT automatically received a paging alert, after the surgery. The RT reviewed the patient postoperatively and instituted CPAP or bi-level positive airway pressure (BiPAP), as indicated. We collected data on triggers for the automated alerts and utilization of CPAP and BiPAP. We reviewed risk-management data to analyze the effect of this intervention on postsurgical sudden-onset acute respiratory compromise.


RESULTS
Of 7,422 patients who presented for surgery over a 5-month period, 766 had an OSA diagnosis or OSA risk factors. There were an average of 7-8 alerts per work day (range 2-18 alerts per day). On average, 2 patients per day were treated with CPAP/BiPAP in the post-anesthesia care unit or the postoperative general ward as a result of the alerts. The median paging alert time was 10:30 am. There were no episodes of sudden-onset postoperative acute respiratory compromise after institution of the OSA alert system.


CONCLUSIONS
As part of a hospital-wide postoperative policy, our automated OSA alert and perioperative RT system helped prevent sudden-onset acute respiratory compromise in postoperative patients with OSA or at risk of OSA.
Ramachandran
Satya Krishna
SK
Department of Anesthesiology, University Hospital, 1 H427, University of Michigan, Box 0048, 1500 E Medical Center Drive, Ann Arbor, MI 48109-004, USA. rsatyak@med.umich.edu
Kheterpal
Sachin
S
Haas
Carl F
CF
Saran
Kelly A
KA
Tremper
Kevin K
KK
D000328:Adult; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D009870:Operating Room Information Systems / Q000458:organization & administration*; D019990:Perioperative Care; D010865:Pilot Projects; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012138:Respiratory Therapy; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*