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Developing a Perioperative Sleep Management Program

Developing a Perioperative Sleep Management Program. Sensible. Simple . Effective . Reaching out to more patients. Reasons to Integrate a Perioperative Apnea Program. Increasing Prevalence of Apnea 4% - Estimated prevalence of OSA in middle-aged men. 24% -

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Developing a Perioperative Sleep Management Program

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  1. Developing a PerioperativeSleep Management Program Sensible. Simple. Effective. Reaching out to more patients.

  2. Reasons to Integrate a Perioperative Apnea Program • Increasing Prevalence of Apnea • 4% - Estimated prevalence of OSA in middle-aged men. • 24% - Percent of U.S. men suffer from some form of sleep disordered breathing (SDB). • ASA Practice Guidelines • Joint Commission Focus • Reimbursement Changes • Reduce Liability Claims • Improving Patient Care • Reduce Adverse Events, Decreasing: • Hospital Re-admissions • Extended PACU stays • Unanticipated ICU admissions New England Journal of Medicine. 1993; 328; 1230-1235. ASA Task Force. Anesthesiology 2006; 104:1081–93.

  3. Reasons for Apnea Screening • SCREENING IDENTIFIES PATIENTS THAT WOULD NOT SEEK TREATMENT OTHERWISE. • Undiagnosed Apnea Patients Pose the Highest Risk • Known apneics make up a small portion of the population undergoing surgery. • Over 28 million Americans suffer from OSA, 20 million going undiagnosed & untreated. • Research shows preoperative identification of OSA & use of perioperative precautionary measures improves patient outcomes. Finkel, et. al. Sleep Review July-Aug 2006. Gupta, et. al.. Mayo Clinic Proc. 2001; 76:897-905.  Moos, et. al. ANAA Journal. June 2005. Vol 3, No 3. ASA Task Force. Anesthesiology 2006; 104:1081–93.

  4. Apnea, Anesthesia & Pain Management A combination of factors put apnea patients at higher risk, including: Lingering anesthetics Amount/type of pain medications used Decreased monitoring Marked REM rebound Finkel, et. al. Sleep Review July-Aug 2006. Gupta, et. al.. Mayo Clinic Proc. 2001; 76:897-905.  Moos, et. al. ANAA Journal. June 2005. Vol 3, No 3. ASA Task Force. Anesthesiology 2006; 104:1081–93.

  5. Financial Risk Reduction • Implementing a Perioperative Apnea Management Program Prevents or Reduces Risk of: • Never Events • Waived Fees • Possible Remunerative or Punitive Repercussions • Non-payment for Unexpected Medical Events • National movement to stop paying for these types of events • CMS Recovery Audits

  6. Cost Benefit- Case Study Findings Example Case Study Findings -Savings on at-risk patients -Increased revenue through PSG & DME

  7. Saving Money & Increasing Opportunities Case Study Findings: At Risk Patients = Greater Costs for Hospitals Case Study Findings Not Identifying at Risk Patients? Deduct from Your Bottom Line. *From a Patient Pool of 20,000: • 340Patients - At Risk Of Post-operative Respiratory Failure • 9 Additional Days - Spent In Hospital By At-risk Patients on Average • $1,900 – Hospital Cost Per Day = $5,865,680 Total Additional Costs

  8. Saving Money & Increasing Opportunities Case Study Findings: Monitoring Saves Money & Creates Opportunity Saving Money $1,759,704 - Amount Saved with Objective Screening in Case Study Opportunity through the Sleep Lab & DME +$446,080 - Gross margin for additional PSG testing (to confirm & initiate therapy) brought on by patients identified during pre-operative screening. +$170,000 - Net Revenue for DME

  9. Problems with Common Screening Methods In-lab Polysomnography (PSG) Questionnaires • Subjective • Simplistic stratification • i.e. high or low risk • Not specific • i.e. high # of false-positives- Leads to unnecessary testing or delayed surgery • Cannot indicate type/severity of SDB • Costly • Impractical for Screening • Population is too large – Would delay surgery • Can Take Days or Weeks to Receive Results • Higher refusal/drop-out rates Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea.Anesthesiology 2006; 104:1081–93. STOP Questionnaire; A Tool to Screen Patients for Obstructive Sleep Apnea. Chung, et. al.. Finkel, et. al.. Sleep Review July-Aug 2006. Magalang, et. al. Chest2003; 124; 1694-1701

  10. Meta-analysis of OSA Questionnaires Screening Test Reliability & Summary Recommendations for Preoperative Use • Many of the most commonly used preoperative screening questionnaires are considered to have poor accuracy. *DOR combines data on sensitivity and specificity to give an indication of a test’s ability to rule in or rule out a condition. Derived from Ramachandran, et. Al. Anesthesiology, V 110, No 4, Apr 2009

  11. “S.O.S.” • Subjective Objective Screening • Research shows a combination approach can be the most feasible & effectivemethod The S.O.S. Approach Subjective Screen Use questionnaire (e.g. STOP; STOP-BANG; Berlin) to screen everyone The population at risk is often large and will often include many patients with low risk. A much smaller subgroup with very high risk will require pre-op intervention. Objective Screen Oximetry (e.g. SatScreen) devices are widely used because of affordability, high predictive value, & minimal patient impact. Identifies the high risk subgroup. Hwang, et. al. Chest2008; 133; 1128-1134. 

  12. Patient Safety, IncTechnology Breakthroughs Patents High resolution oximetry with Digital pattern analysis & recognition SatScreen • Oximetry screening • FDA cleared acquisition, analysis & reporting software Patient Safety Connection Center • Oximetry & HST software management platform

  13. Why SatScreen? • Accurate & Cost-Effective • Results in Minutes • Easy to Read – Green to red indices for important information • Indicates Arousal Failure & Hypoventilation Syndromes- These patients are at higher risk of post-op respiratory failure • Highlights Frequency of Events & Severity of O2Desaturations Most oximetry software only report raw data, ODI & O2 ranges. Bloch. Chest 2003; 124; 1628-1630.  ASA Task Force. Anesthesiology 2006; 104:1081–93. Madani. Advance for Respiratory Care and Sleep Medicine. Posted on January 7, 2009.

  14. GetStarted • Define your protocol for at risk patients • Determine your Screening Protocol • Gather your team & assign responsibilities • Practice Guidelines • If patient is identified as at risk, follow ASA guidelines or preferred protocol • Develop discharge instructions / plan Questions? We want to help you make your organization’s OSA screening program a success. Please contact us at: 1-888-666-0635 support@patientsafetyinc.com

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