Background The Liverpool Sleep Centre provides secondary and tertiary level services for sleep disorders. We recently introduced a computer guided consultation (CGC); the CGC has comprehensive, sleep guideline based, clinical decision support system (CDSS) algorithms embedded throughout and creates an Electronic Patient Record. The initial review is by a sleep technician; in proof of principle work, this was as effective as specialist sleep physician assessment. The system also has also a ‘clinical dashboard’ designed to highlight patients of concern and facilitate multi-disciplinary team management. We wished to examine the discriminatory value of the technician review particularly in identifying those needing prompt management.
Methodology To confirm faced validity we reviewed the dashboard alerts in patients from March 1st to June 22nd 2021 following CGC implementation. 326 patients with suspected Obstructive Sleep Apnoea(OSA) were assessed using the CGC; 170 male, mean(SD) age 49.1 (14.1) years, BMI 35.9(9.3). The risk profiling of the patients was reviewed; 326 people had an initial consultation at the time of analysis 42 had incomplete sleep study data.
Results Of the 284 with sleep study results, average ESS was 10.5, mean(SD) AHI 18.7 (19.6). A diagnosis of OSA(S) was given in 196 (69%), 51 (16%) had normal polygraphy and in 37(13%) further review was advised. Regarding overnight oxygen saturations 173(61%) had an average < 94%, 98 had >20 minutes SpO2 < 90%. 132 had bicarbonate recorded with 49 > 27mmol/L. There were 223 drivers, Group 1=212; Group 2=8; drivers reporting sleepiness when driving 26 of 223 (12%) (Group 1=24/212; Group 2=1; Provisional=1).
Conclusion The implementation the CGC with standardised consultations and dashboard management system resulted in the identification and prioritisation of sleepy drivers including 8 Group 2 (HGV) for prompt management. Twenty four people (8%) had definite evidence of obesity hypoventilation SpO2 <90% for > 20 mins and bicarb > 27. Only 37(13%) were identified as needing further sleep specialist diagnostic review. The CGC approach in real life performs as was seen in the validation work. The approach increases the capacity and capability of a department by allowing safe delegation of a significant proportion of initial assessments.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.