338 - Screening for Sleep Disordered Breathing among Patients Hospitalized for Asthma Exacerbation

Poster Number: 338
Publication Number: 338.323

Daniel A. Ignatiuk, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Neepa Gurbani, Cincinnati Children's Hospital Medical Center, cincinnati, OH, United States; Christine L. Schuler, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer M. Albrecht, Cincinnati Children's, Cincinnati, OH, United States; Amanda Waits, Cincinnati Children's Hospital Medical Center, Batavia, OH, United States; Carolyn M. Kercsmar, Cincinnati Children's Hospital Medical Center, Blue Ash, OH, United States

Background: Children with asthma have an increased prevalence of sleep disordered breathing (SDB), with asthma severity positively correlated with SDB risk. Treating SDB improves asthma control, and untreated SDB in pediatric patients has been associated with increased risk for serious comorbidities.

Objective: To design and implement a screening process for SDB in patients hospitalized for asthma exacerbation using quality improvement methodology. We sought to improve screening for SDB from zero to 60% from July 2019 to December 2021.

Design/Methods: A multidisciplinary team initiated a screening process for SDB using the Michigan Pediatric Sleep Questionnaire (PSQ) among patients 2-18 years old hospitalized for asthma exacerbation; the PSQ has been validated in children with asthma. A positive score was defined as ≥ 0.33. A key driver diagram, simplified FMEA, and pareto charts were used to develop and implement the screening process. Key interventions/PDSAs included engagement of respiratory therapists to complete the PSQ and document scores (initially on paper, then electronically), project education for staff and physicians, modifications to electronic order sets, and integration of PSQ results into a routinely used Childhood Asthma Risk Assessment Tool (CARAT) flowsheet in the electronic medical record. Demographic data and PSQ scores were collected. A run chart was used to track progress and descriptive statistics were generated.

Results: Among patients admitted for asthma exacerbation (n=1826), 42% were female, mean age was 7.1±4.9 years, and race was 40% Caucasian, 47% African American, and 13% other races. 1230 patients (67%) had a PSQ completed (mean score 0.21±0.19). Of screened patients, 304 (25%) had a positive PSQ (mean score 0.49±0.13); of patients with a positive score, 58% were female, mean age was 8.4±4.7 years, and 39% were Caucasian, 51% African American, and 10% other races. Approximately one year after the project began, we exceeded the goal of screening 60% of children admitted for asthma. Continued improvement in the proportion of children screened occurred over the second project year and has been sustained at over 80%.Conclusion(s): We successfully implemented a screening process for SDB at our institution, reaching our screening goal by the end of the project’s first year. The high proportion of positive screens reinforces the importance of examining this high-risk population. Ongoing goals include relaying results to primary care providers and automating sleep medicine referrals for screen positive patients to determine the need for further evaluation and treatment.
Run Chart for PSQ Screening of Patients Admitted for Asthma Exacerbation