Quality Improvement in a Sleep Clinic: To increase the capacity and reduce the time to treatment for patients with Obstructive Sleep Apnoea

Abstract

Introduction: We redesigned our Sleep Apnoea patient pathway to be a patient-focused service where standard care approaches were used in the diagnosis and management of Obstructive Sleep Apnoea.

Aim: To increase the capacity and decrease the ‘Time to Treatment’ for OSA from 32 weeks to 12 weeks within a 9-month project window.

Implementation: To diagnose the problem (factors contributing to the delays) a Pareto Analysis was performed. Using run charts we identified variations in attendance (waste) over a 12-month period and undertook an enquiry to understand the causes. Patient engagement was a primary driver to assist in the redesign of both the clinic setup and the patient therapy review pathway. We devised a measurement plan to determine if our changes led to an improvement. Using Plan-Do-Study-Act (PDSA) methodology an MDT team identified ways to reduce the time to treatment for OSA.

Outcomes: A new Sleep Clinic procedure was established. The clinic was moved from the outpatients to the Respiratory Physiology Laboratory (co-location to the diagnostic and treatment hub) during scheduled downtime in this clinical area. A pre-clinic MDT and an electronic proforma were implemented for patient histories. The CPAP pathway was redesigned and optimised as a balancing measure.

Conclusion: The waiting time from initial referral to review in the clinic was significantly reduced from 196 days to 14 days. The variability in attendance was also reduced and the number of new patients seen in the clinic has increased from 4 patients per month to 15. 244% more new patients were seen at the clinic - an increase from 48 in 2018 to 165 by year-end, 2019.