Rationalising requests for preoperative sleep studies and postoperative HDU beds: a quality improvement project in paediatric ENT patients undergoing elective surgery

BACKGROUND: Sleep disordered breathing represents a spectrum of upper airway obstruction including snoring, increased respiratory effort and obstructive sleep apnoea. An increasing demand for paediatric preoperative sleep studies and postoperative high dependency unit (HDU) beds was having a significant impact on service delivery at this ear, nose and throat (ENT) unit. METHODS: Retrospective and prospective review of all paediatric sleep study requests over a 30-month period in a single tertiary ENT department. Data were collected on indication for and result of sleep study, patient outcome, operative details and HDU bed occupancy. During the study period, a ‘Sleep Study’ proforma was introduced which incorporated the ‘I’m Sleepy Score’ (ISS) and ENT-UK national guidelines. RESULTS: Retrospective review included 198 sleep studies, of which 62% (n=118) showed no evidence of obstructive sleep apnoea (OSA). There was little consistency in patients’ sleep study results and need for monitoring on HDU following adenotonsillectomy. Prospective review following intervention included 60 patients, of which 62% (n=37) showed evidence of OSA. The mean ISS in this cohort was 4.7. Only those with moderate-to-severe OSA or with relevant risk factors underwent overnight HDU observation. The number of sleep study requests fell by >50%; from 11 per month to 5 per month. The total HDU bed occupancy was reduced by 50% following intervention (from n=18 to n=9). CONCLUSION: The use of the ISS and incorporation of ENTUK’s recommendations has reduced the number of negative sleep studies being requested and has rationalised the number of paediatric HDU bed requests being made. This has helped provide a prudent elective paediatric ENT service in this unit with corresponding cost benefits.