Authors (including presenting author) :
Lit MPK, Lee KH, Ng CK, O WH, Chow PS, Wong YH, Mak FT, Chan YH, Chan WMJ
Affiliation :
Respiratory Division, Department of Medicine, Queen Elizabeth Hospital (QEH)
Introduction :
SBD especially patient with Obstructive Sleep Apnoeas (OSA) is common in HK. The prevalence rate amongst middle-aged Chinese men and women was 9% and 3.7% in community respectively. Polysomnography (PSG) is the gold standard diagnostic test while Continuous Positive Airway Pressure (CPAP) therapy is the corner stone treatment for OSA. However, the demand –supply imbalance causes long waiting time and waiting list for the diagnostic tests in QEH. An ISSM was implemented for better service arrangement.
Objectives :
1. Increase accessibility of sleep diagnostic tests to patients
2. Decrease long waiting time of sleep diagnostic tests
3. Optimize treatment outcome
4. Improve accuracy of the tests.
Methodology :
ISSM was commenced since 1st October, 2022. It is an inter-hospital collaboration programme between Wong Tai Sin Hospital (WTSH) and Queen Elizabeth hospital (QEH). Service model with 4 beds 4 nights; In- laboratory tests (In-Lab) (75%) + home study (25%) would be adopted in Kowloon Central Cluster targeting to provide 700 supervised In-Lab tests at WTSH, 380 home studies at QEH, 200 nurse clinic sessions and 680 new and 2,260 follow-up attendances to doctor’s out-patient clinic through collaboration between QEH and WTSH annually.
The programme includes cross -hospital appointment booking, manual scoring for sleep studies, CPAP educational provision, compliance monitoring and integrated medical and nurse clinics for better patient management. The inter-hospital sleep services workflow and logistic including triage criteria, treatment priority and category standardization between WTSH & QEH were formulated. A new service of home studies included 2 consecutive nights for tele-monitoring of auto-CPAP (ACPAP) titration. Pressure parameter adjustment will be performed through web cloud. Phone follow-up by respiratory nurses after first night of ACPAP titration to confirm the progress and tackle the problems if necessary.
Result & Outcome :
It was a preliminary 4-month’s review from October, 2022 to Jan, 2023. There were 237 patients were triaged to WTSH for supervised tests whereas 294 patients to QEH for HSAT respectively. A total of 35 patients refused to perform the tests at WTSH and preferred in QEH. The average waiting time of urgent in-lab PSG were improved with 70% (10 vs 3 weeks) and urgent CPAP with 50% (8 vs 4 weeks) at QEH. The mean waiting time of elective in-lab PSG were markedly reduced 85% (165 vs. 24 weeks). The success rate of home studies was 98.6%. Only 1 patient failed ACPAP and 4 patients with ACPAP tolerance were improved after tele-monitoring with phone follow-up
Conclusion
The ISSM programme markedly shorten the waiting queue of urgent and elective In-Lab PSG and urgent CPAP. Home studies including home-PSG & ACPAP also play a significant role in waiting time reduction. A long-term outcome review in various aspects will be explored afterwards.
