Obstructive sleep apnea (OSA) is an under-recognized condition that results in morbidity and mortality. Postoperative complications including medical emergency team activation (META) are disproportionally increased among surgical patients at risk for OSA. A systematic approach is needed to improve provider recognition and treatment, but protocols demonstrate improvement from META are lacking. As part of a multidisciplinary quality improvement project, DOISNORE50 (DIS), a sleep apnea questionnaire and proactive safety measures, was algorithmically applied to all perioperative patients.

Consecutive sleep screening was conducted among perioperative patients. Of the 49,567 surgical navigation center patients, 11,932 had previous diagnosis of OSA. Of the 37,572 (96%) patients screened with DIS, 25,171 (66.9%) were Low Risk (DIS <4), 9,211 (24.5%) At Risk (DIS ≥ 4), and 3,190 (8.5%) High Risk (DIS ≥ 6) for OSA, respectively. High Risk patients received same-day sleep consultation. On day of surgery, patients with Known OSA, At Risk, and High Risk for OSA received an “OSA Precaution Band.” An electronic chart reminder alerted admission providers to order postoperative continuous positive airway pressure (CPAP) machine and sleep consult for patients High Risk for OSA.

Implementation of a comprehensive program was associated with increased sleep consultation, sleep testing, and inpatient CPAP use (p < 0.001). For every 1,000 surgical patients screened, 30 fewer META, including rapid responses, reintubation, code blues, and code strokes were observed. However, inpatient sleep consultation and inpatient CPAP use were not independently associated with reduced META. In the subgroup of patients hospitalized longer than 3 days, inpatient CPAP use was independently associated with reduced META.

In this single-center, institution-wide, multidisciplinary approach quality improvement project, a comprehensive OSA screening process and treatment algorithm with appropriate post-operative inpatient CPAP therapy and inpatient sleep consultations was associated with increased CPAP use and reduced META. Further prospective studies are needed to assess cost, feasibility, and generalizability of these findings.