A Quality Assurance Program to Improve Referral Services in a Sleep Disorders Clinic in Southeast Idaho

Obstructive sleep apnea (OSA) is a sleep breathing disorder posing increased risk for morbidity and often associated with co-existing disorders, such as, diabetes, hypertension, and heart failure. While prevalence rates vary, it is proposed that 26-32% of the United States population has a high probability of having OSA (National Sleep Institute; Grover et al., 2011). The "gold" standard test for diagnosis of OSA is the standard polysomnography (SPSG) requiring the patient to sleep overnight in a sleep disorders center attended by a polysomnography technician. For a number of reasons, unattended home portable monitoring (PM) testing is gaining in popularity and reimbursed by Medicare and other 3rd party payers. Unattended home studies do not yield as much diagnostic data, and often result in misdiagnosis and need to be repeated, thus delaying diagnosis. The purpose of this project was to evaluate the feasibility and develop a business plan for a program of attended PM home sleep studies to improve referral and diagnostic services to patients treated at the Pocatello Sleep Institute (PSI). Objectives for this project included: 1) Completion of a retrospective chart audit of 100 patients at the PSI to determine inefficiencies and the number of studies needing to be repeated; 2) Completion of a feasibility study and business plan for attended home PM to improve referral and evaluation services at PSI; 3) Presentation of findings and recommendations to the staff of the PSI; and 4) Submission of an abstract for a poster presentation at a professional conference. After securing Institutional Review Board approval, a retrospective chart audit was administered in 100 patients who underwent unattended home PM sleep apnea testing between July 1, 2011 through July 31, 2012. Of the 100 sample charts, 30 required repeat testing in all cases due to operant (ie. patient) error. Potential inefficiencies identified included 1) lack of patient education regarding equipment use prior to unattended PM testing and 2) possible deficiencies in screening by referring providers. The business feasibility plan will be presented to the sleep center staff on December 10, 2012. Future chart audits are planned to evaluate results of program changes based upon these recommendations. An abstract has been submitted, and if accepted will be presented in May 2013 at the Utah Nurse Practitioners Annual Pharmacology Conference in Salt Lake City, Utah.