SCREENING FOR OBSTRUCTIVE SLEEP APNEA IN PATIENTS WITH ISCHEMIC STROKE AND TRANSIENT ISCHEMIC ATTACK

Sleep related disordered breathing is an independent risk factor for ischemic stroke. Research suggests that treatment of Obstructive Sleep Apnea (OSA) improves neurologic recovery, quality of life, and is integral to secondary prevention of stroke but screening is often overlooked. In this quality improvement project, the aim was to improve OSA screening rates in patients with ischemic stroke or transient ischemic attack (TIA) who were admitted to Hennepin County Medical Center. The objectives were to evaluate baseline documentation of OSA screening in ischemic stroke patients, develop effective protocols to encourage screening, and measure the post intervention rate of screening documentation and resulting sleep referrals. Two sets of interventions were implemented, in July 2015 and March 2016, including an education session for resident physicians, an electronic stroke discharge note template, and email reminders. Retrospective chart review was conducted on ischemic stroke and TIA patients discharged over two consecutive months in 2014, 2015, 2016, and 2017, to collect OSA screening and referral data before and after each intervention, as well as a year later, to assess retention. Surveys were filled out before and after the interventions, to assess physicians’ reported screening practices and behaviors towards the discharge template. The rate of OSA screening in ischemic stroke and TIA patients at discharge increased from baseline 2.4% in 2014 to 24.1% in 2015 following intervention. It further increased to 66.0% in 2016 after continued efforts for implementation. After reiteration, in 2017, the OSA screening rate improved to 69.4%. All patients (100%) who screened positive, had a sleep referral ordered at discharge. Physician survey before and after interventions found increase in self-reported screening rate (69% to 100%) and increase in satisfaction with the discharge template. Implementation of an education session, stroke discharge note template, and email reminders positively correlated with screening rate and referral to the sleep clinic. The substantial gains, compared to baseline, were retained a year following the interventions. Physician self-reported screening rate and satisfaction with discharge template both increased. NA.