Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
NeuroCare Center for Sleep, Newton, Massachusetts.
J Clin Sleep Med. 2021 Jul 1;17(7):1355-1361. doi: 10.5664/jcsm.9190.
Polysomnography is a common outpatient procedure and the rate of adverse events is considered low. Due to the emergence and use of home sleep apnea testing, the patient population presenting for in-laboratory testing may have greater medical complexity, suggesting greater risk for in-laboratory adverse events. We believe that there is a greater need for standardized protocols to triage medically vulnerable populations and for formalized training of sleep technicians to respond to safety events.
The sleep laboratories affiliated with the Beth Israel Deaconess Medical Center system developed a referral triage protocol for patients undergoing polysomnography and a training protocol for sleep technicians with a formalized response to medical incidents. Safety events occurring from January 2016 to January 2020 were documented and patient demographics, referral characteristics, event characteristics, and outcomes were analyzed.
Sixty-five safety events occurred over this period, with a rate of 1:147 studies. The most common events were chest pain (20/65, 31%), shortness of breath (13/65, 20%), and vital sign abnormalities (12/65, 18%). Patients experiencing events were 49% (32/65) female, with a median age of 57 years (range, 19-91 years); 60 of 65 (92%) had documented medical comorbidities, with a median of 3 documented medical or psychiatric comorbidities (range, 0-9). With the formalized response protocol, the time from incident identification to activation of the appropriate response was a median of 3 minutes (range, 0-47 minutes).
The incidence of in-laboratory safety events may be greater than previously described due to the widespread use of home sleep apnea testing. Implementation of formalized response protocols and sleep technician training may be necessary to meet the needs of an increasingly medically complex population.
多导睡眠图是一种常见的门诊程序，不良事件的发生率被认为较低。由于家庭睡眠呼吸暂停测试的出现和使用，接受实验室测试的患者人群可能具有更高的医疗复杂性，这表明实验室测试中的不良事件风险更高。我们认为，需要制定标准化的协议来对医疗脆弱人群进行分诊，并对睡眠技术人员进行正式的培训，以应对安全事件。
隶属于 Beth Israel Deaconess Medical Center 系统的睡眠实验室为接受多导睡眠图检查的患者制定了转诊分诊协议，并为睡眠技术人员制定了培训协议，对医疗事件有正式的应对措施。记录了 2016 年 1 月至 2020 年 1 月期间发生的安全事件，分析了患者人口统计学特征、转诊特征、事件特征和结果。
在此期间发生了 65 起安全事件，发生率为 1:147 例。最常见的事件是胸痛（20/65，31%）、呼吸急促（13/65，20%）和生命体征异常（12/65，18%）。发生事件的患者中，女性占 49%（32/65），中位年龄为 57 岁（范围 19-91 岁）；65 例（92%）患者有记录的合并症，中位数为 3 种记录的合并症（范围 0-9 种）。有了正式的应对协议，从识别事件到激活适当应对措施的时间中位数为 3 分钟（范围 0-47 分钟）。
由于家庭睡眠呼吸暂停测试的广泛使用，实验室安全事件的发生率可能高于之前的描述。实施正式的应对协议和睡眠技术人员培训可能是满足日益复杂的医疗人群需求的必要条件。
