Abstract
Introduction Rising demand for sleep services requires our service to integrate newer, more efficient respiratory polygraphy technology into our diagnostic pathways.
An initial audit of 103 patients showed that 50% of our patients aged <40 years required respiratory polygraphy or full polysomnography (PSG) despite oximetry and clinical review. In contrast, only 16% of patients aged ≥40 years required further investigation to reach a definitive management decision.
Methods We undertook a service improvement project to assess the impact of using respiratory polygraphy (WatchPAT) as the initial diagnostic test in patients aged <40. The outcomes evaluated were: number of appointments needed to reach a definitive management plan, cost effectiveness, and patient satisfaction. Patients were randomly selected from the top waiting list and invited to participate.
Preliminary results To date, 21 patients have completed the pilot pathway (of a final expected total 55 patients). A clinical decision was made in the first consultation in 19 (90.4%) of patients (CPAP = 13, discharge = 3, other = 3). Only 2 patients (9.5%) were referred for inpatient respiratory polygraphy followed by a second clinic appointment before management decision. When extrapolated and compared with our baseline audit this shows a saving of 46 clinical review appointments per 100 new patients seen.
Combining these extrapolations with the major costs involved estimates that the new pathway would save £9,133 per 100 new patients aged < 40.
