Clinical audit
Prospective audit of a respiratory sleep disorders service at
District General Hospital level
Paul C Deegana c, Brendan G Cooperc, John R Brittonc, Nicholas S Jonesb, William J M Kinneara
a University
Hospital Nottingham, Nottingham, UK Department
of Respiratory Medicine, b Department of Otorhinolaryngology, c Department
of Respiratory Medicine, City Hospital Nottingham, Nottingham, UK
Correspondence to: Dr Paul Deegan, 5Z Link, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK
Accepted 14 January
1999
This study was designed to examine the organisation and
outcomes of a District General Hospital respiratory sleep service, since data are lacking on the management of sleep-disordered breathing at this level. Questionnaires and case-notes review were used to assess
the management of 119 consecutive patients referred with suspected
sleep-disordered breathing. Patients diagnosed with sleep-disordered
breathing were assigned nasal continuous positive airway pressure
(nCPAP), ear/nose/throat (ENT) surgery or simple measures (eg, weight
loss). There were six non-attenders. At 12 months follow-up, 33 patients had been assigned to nCPAP, 25 to ENT surgery, and 37 to
simple measures. Of the remainder, nine had alternative diagnoses, two
were still being assessed and seven were lost to follow-up. Patients
prescribed nCPAP (81% compliance) had significant symptomatic
improvements with low dissatisfaction rates (20%); patients on simple
measures did not improve (33% dissatisfied); only half assigned
surgery had it performed, with 42% awaiting surgery and dissatisfied.
Interspecialty referral resulted in major delays (mean 16 weeks).
Referral letters were generally unhelpful in deciding on the
appropriateness of initial referral (respiratory physician
vs ENT). nCPAP was generally effective in
improving symptoms, with a high level of patient satisfaction, while
simple measures did not improve symptoms and were associated with lower
satisfaction levels. Waiting times to ENT surgery can be long and
patients express significant dissatisfaction. Referral letters are not
useful in directing initial referral. Services should be co-ordinated
between respiratory and ENT specialties to reduce waiting times and
improve patient satisfaction.
Keywords: sleep-disordered breathing; audit; nasal continuous positive airway pressure; snoring
© 1999 by The Fellowship of Postgraduate Medicine
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