Background The Liverpool Sleep Centre provides secondary/tertiary level care for a range of sleep disorders. An increasing volume of referrals and the impact of Covid threatened to overwhelm the service resulting in increasing clinical risk and decreased patient satisfaction. We describe how the use of technology addressed these challenges through the implementation of a Computer Guided Consultation system i.e. clinical decision support software (CDSS).
Methodology The CDSS is a digital ecosystem comprising multiple intelligent consultations encompassing the entire OSA pathway including Assessment and diagnosis, CPAP set up, CPAP monitoring and issuing consumables thus acting as an end to end system solution and an Electronic Patient Record. The CDSS also features a ‘clinical dashboard’ allowing the service to track activity, monitor RTT performance and identify high risk patients e.g. sleepy drivers, hypoventilation in ‘real time’.
Results Prior to implementation of the CDSS, all suspected OSA referrals underwent a sleep study and the results of which together with the information contained in the referral letter would have been reviewed by a Consultant in a ‘Virtual clinic’ with treatment decisions made in such clinics. In order to meet this demand, the service required 8 clinics weekly (5 Consultant ‘Virtual’ clinics consisting of 20 patients each and 3 ‘Combined’ Consultant/Physiologist clinics). Since March 1st to June 2021 following CDSS implementation, 325 patients (see table 1 for demographics) with suspected OSA were assessed by paramedical staff using the CDSS. Only 15% of these patients subsequently required a Consultant review either in a ‘Virtual’ or a ‘Face to Face’ manner (translating into just 0.5 clinics weekly), no ‘combined’ clinics were required with the ‘clinical dashboard’ used to highlight difficult cases for a weekly MDT. The CDSS generates automated clinical letters for each review thus greatly reducing secretarial time/costs for the service as no typing is required.
Conclusion The implementation of an intelligent Computer Guided Consultation system has resulted in pathway transformation enabling scarce Consultant resource to be channelled to where it is most required and enhancing service capacity, efficiency and patient safety. Adopting the system results in multi-level health economic benefits and facilitates greater service oversight.
Please refer to page A192 for declarations of interest related to this abstract.
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