Rapid sleep apnoea diagnosis
GPs have transformed the way they manage obstructive sleep apnoea syndrome (OSAS) with a quick new service that reduces hospital referrals.
They use a 'triple lock' of clinical assessment, Epworth sleepiness score and overnight pulse oximetry, to diagnose OSAS promptly and refer suspected cases to the sleep clinic for treatment.
GP partner Dr Malav Bhimpuria said that previously all suspected cases had been referred to the sleep clinic, while others were not referred at all and some referred inappropriately.
'Referral meant lots of delays for patients and created costs all along the way. We thought that if we had a small piece of kit in the community, then we could streamline the pathway and see the patient in a familiar environment.'
The GPs secured practice-based commissioning savings to buy an oximeter (about £430) and the software for interpretation (about £400).
When they suspected a patient had OSAS, they would assess them, give them an Epworth scale and loan out the oximeter.
The patient would return the next day and have the data uploaded to the surgery computer system to create a report.
Dr Bhimpuria said: 'This whole process only takes about a minute and the oximeter has its memory cleared for the next user. The interpretation is also straightforward, because apnoeas are readily recognised.'
Of the first 21 patients to use the service, eight had suspected OSAS and were referred to the sleep clinic. Of those, seven had the diagnosis confirmed by a specialist, and the remaining patient was diagnosed with restless legs syndrome.
'Since the service was introduced, our referrals have fallen,' said Dr Bhimpuria, 'and what we are referring is more appropriate.
'Indeed, if all 21 patients had been referred to the sleep clinic as we did previously, then the overall number of referrals would have increased year on year. So our new service has also had a beneficial impact on the local health economy.'
Dr Bhimpuria said all patients had received the oximeter within one working day of seeing the GP and the feedback had been excellent.
'We have had no negative feedback from the patients - they love the service. It's all part of holistic care. My big passion is patient care and I like finding ways to bring diagnostics closer to the patient. This service fits in with that ethos.'
He said the key point was that they were not using the oximeter in isolation.
'The kit is just one part of the triple lock assessment. At the end of the day we are still using our common sense but the oximeter helps as a diagnostic aid.'
Dr Bhimpuria is chairman of the local commissioning consortium, Hunts Care Partners, covering 14 practices and 95,000 patients.
The group is now considering buying the oximeter kit for three or four practices so that other practices in the group can refer suspected cases to them for testing.
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