School of Medicine and Health Sciences Poster Presentations

Title

Improving the Screening Process for Sleep Apnea in the Internal Medicine Residents' clinic

Document Type

Poster

Keywords

Sleep Apnea; Quality improvement; Screening

Publication Date

Spring 2017

Abstract

Introduction:

Sleep apnea is a common medical problem andwell-recognized entity in the medical field as it is associated with multiple comorbidities. However, screening for this condition is not systematic in our resident medical clinic and is left up to the physician's suspicion. There are validated screening tools that are widely available for use and Berlin Questionnaire is one of them. It is 86% sensitive and 77% specific in primary care settings.our team has noticed that identifying people with sleep apnea is usually left to the physician's clinical suspicion.

Aim:

Over a period of five weeks, we will increase the percentage of appropriate patients referred for sleep study identified with sleep apnea inin the internal medicine residents' clinic by 50% through implementing the use of Berlin Questionnaire.

Method:_x000D_

Baseline data on appropriate referral rates were gathered by chart review and use of the Berlin Sleep Apnea Questionnaire, without involving the primary care physician. Our intervention was the use of the screening tool during appointments scheduled for physicals. We did two PDSA cycles to determine the best way to implement this tool. In the first cycle, the form was available to all patients coming for their annual physical visit. In the second cycle, the physicians were given the screening tool to use with patients as they deemed appropriate.

Results:

At baseline, 7 50 percent of 14 sampled patients (50%) screened positive on the Berlin Questionnaire. About 43 percen Three of the seven patients (43%) were t of them only were referred by their physicians for sleep testing. During the first PDSA cycle, no forms were returned, so no data were collected. In the second cycle, two of the three sampled patients screened positive; however, 50 percent of those screened positive were referred.

Discussion:

We found a low uptake on using the screening forms in both cycles. In the first cycle, it was one of many forms the patients need to fill and discuss with their physicians and none were returned to the investigator. In the second cycle, residents were asked to use the screening form when they deemed it appropriate. There was still a low uptake on using the form.The first PDSA cycle did not work as either the patients did not voluntarily pick up the forms or show them to their physiThe other physician appropriately referred the patient but that patient answered most questions leading to high clinical suspicion of sleep apnea.

Conclusion:

Screening for sleep apnea is challenging despite being a common problem and having screening tools readily available. A complicated form filled during a visit in a busy clinic may not be ideal for screening. Likewise, utilizing multiple forms during a single visit may decrease the likelihood that patients and physicians will complete them. Further PDSA cycles using different visit types or different screening tools, are needed to determine easier ways to increase rates of appropriate referrals for further testing.

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Comments

Poster to be presented at GW Annual Research Days 2017.

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Improving the Screening Process for Sleep Apnea in the Internal Medicine Residents' clinic

Introduction:

Sleep apnea is a common medical problem andwell-recognized entity in the medical field as it is associated with multiple comorbidities. However, screening for this condition is not systematic in our resident medical clinic and is left up to the physician's suspicion. There are validated screening tools that are widely available for use and Berlin Questionnaire is one of them. It is 86% sensitive and 77% specific in primary care settings.our team has noticed that identifying people with sleep apnea is usually left to the physician's clinical suspicion.

Aim:

Over a period of five weeks, we will increase the percentage of appropriate patients referred for sleep study identified with sleep apnea inin the internal medicine residents' clinic by 50% through implementing the use of Berlin Questionnaire.

Method:_x000D_

Baseline data on appropriate referral rates were gathered by chart review and use of the Berlin Sleep Apnea Questionnaire, without involving the primary care physician. Our intervention was the use of the screening tool during appointments scheduled for physicals. We did two PDSA cycles to determine the best way to implement this tool. In the first cycle, the form was available to all patients coming for their annual physical visit. In the second cycle, the physicians were given the screening tool to use with patients as they deemed appropriate.

Results:

At baseline, 7 50 percent of 14 sampled patients (50%) screened positive on the Berlin Questionnaire. About 43 percen Three of the seven patients (43%) were t of them only were referred by their physicians for sleep testing. During the first PDSA cycle, no forms were returned, so no data were collected. In the second cycle, two of the three sampled patients screened positive; however, 50 percent of those screened positive were referred.

Discussion:

We found a low uptake on using the screening forms in both cycles. In the first cycle, it was one of many forms the patients need to fill and discuss with their physicians and none were returned to the investigator. In the second cycle, residents were asked to use the screening form when they deemed it appropriate. There was still a low uptake on using the form.The first PDSA cycle did not work as either the patients did not voluntarily pick up the forms or show them to their physiThe other physician appropriately referred the patient but that patient answered most questions leading to high clinical suspicion of sleep apnea.

Conclusion:

Screening for sleep apnea is challenging despite being a common problem and having screening tools readily available. A complicated form filled during a visit in a busy clinic may not be ideal for screening. Likewise, utilizing multiple forms during a single visit may decrease the likelihood that patients and physicians will complete them. Further PDSA cycles using different visit types or different screening tools, are needed to determine easier ways to increase rates of appropriate referrals for further testing.