Interventions including education programs, stroke discharge note templates and email reminders improved the screening rates for obstructive sleep apnea in patients with ischemic stroke and transient ischemic attack, according to findings presented at SLEEP 2018, the Annual Meeting of the Associated Professional Sleep Societies.
“As we learn more about the relationship between sleep and stroke, screening patients for obstructive sleep apnea (OSA) is becoming an important part of secondary stroke prevention,” Abby Metzler, MD, neurologist at the Mayo Clinic in Rochester, Minnesota, told Healio Internal Medicine. “We know that the prevalence of OSA is quite high in stroke patients, but in clinical practice, it is not frequently diagnosed in this vulnerable population.”
“In our project, we attempted to improve screening for sleep apnea for patients who had suffered an ischemic stroke or a transient ischemic attack, at the time of discharge from their acute hospitalization,” she added. “Implementing interventions like a discharge order set can efficiently improve medical care.”
To improve OSA screening rates in patients with ischemic stroke or transient ischemic attack, researchers implemented two sets of interventions — one in July 2015 and one in March 2016 — for patients who were admitted to the Hennepin County Medical Center for ischemic stroke or transient ischemic attack. The interventions consisted of an education session for resident physicians, an electronic stroke discharge note template and reminders via email. Over 2 consecutive months in 2014, 2015, 2016 and 2017, researchers conducted a retrospective chart review of discharged patients to collect OSA screening and referral data. Researchers examined data before and after each intervention and again a year later to evaluate retention. Physicians were also given surveys before and after the interventions to assess their screening practices and attitudes about the discharge template.
After the intervention, researchers found that the rate of OSA screening in patients at discharge increased from 2.4% at baseline in 2014 to 24.1% in 2015. Following more implementation efforts, the screening rate increased to 66% in 2016. In 2017, the screening rate was 69.4%. Each patient that tested positive for OSA was given a sleep referral. In addition, based on the physician surveys, researchers found that physicians had an increase in self-reported screening rate (69% to 100%), and demonstrated more satisfaction with the discharge template.
“Successfully increased rates of sleep apnea screening were supported by an education session for physicians, use of electronic medical record templates and email reminders,” Metzler said.
“The ultimate goal of improving OSA screening is to mitigate the negative impact on medical health and quality of life. As it’s one of the risk factors for cerebrovascular disease, screening is important for subsequent intervention for secondary stroke prevention,” she added. “More research is needed to determine both when and how sleep apnea screening should take place, with the goal of decreasing future risk of ischemic stroke or transient ischemic attack for our patients.” – by Melissa J. Webb
Metzler A, et al. Screening for obstructive sleep apnea in patients with ischemic stroke and transient ischemic attack. Presented at: SLEEP 2018, the Annual Meeting of the Associated Sleep Societies; June 2-6; Baltimore.
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