Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Pediatr Pulmonol. 2023 Dec;58(12):3458-3465. doi: 10.1002/ppul.26676. Epub 2023 Sep 13.
Sleep disordered breathing (SDB) may exacerbate asthma and is a treatable comorbidity.
To design and implement a screening process for SDB in patients hospitalized for asthma exacerbation using quality improvement (QI) methods. We sought to improve screening for SDB from zero to 60% from July 2019 to December 2020.
DESIGN/METHODS: A multidisciplinary team used QI methods to screen for SDB using the Michigan pediatric sleep questionnaire (PSQ) in patients 2-18 years hospitalized for asthma exacerbation. Key interventions included: pairing the PSQ screen with another element of routine care (the asthma risk factor screen), educating staff and physicians, engaging respiratory therapists to complete the PSQ and document scores, and modifying the electronic medical record (asthma order set and flowsheet for PSQ score documentation). A run chart tracked progress and descriptive statistics were generated.
There were 2067 patients admitted for asthma exacerbation during this project. The PSQ was completed for 1531 patients (74%) overall. Of screened patients, 360 (24%) had a positive PSQ; the mean age was 8.6 years. Approximately 14 months after the project began, ~90% of children admitted for asthma were being screened; subsequently, >80% of patients were being screened until May 2022. Screening with the PSQ occurred approximately 90% of the time when routine asthma risk screens were completed.
A screening process for SDB was successfully implemented and appeared feasible and sustainable. The high proportion of positive screens reinforces the importance of evaluating for SDB in the high-risk population of children requiring hospitalization for asthma exacerbation.
睡眠呼吸障碍（SDB）可能会使哮喘恶化，并且是一种可治疗的合并症。
使用质量改进（QI）方法为因哮喘加重而住院的患者设计并实施 SDB 筛查流程。我们旨在将 SDB 的筛查率从 2019 年 7 月至 2020 年 12 月从 0 提高到 60%。
设计/方法：一个多学科团队使用 QI 方法，通过密歇根儿科睡眠问卷（PSQ）对因哮喘加重而住院的 2-18 岁患者进行 SDB 筛查。主要干预措施包括：将 PSQ 筛查与常规护理的另一项内容（哮喘危险因素筛查）相结合，对医护人员进行教育，让呼吸治疗师完成 PSQ 并记录分数，并修改电子病历（哮喘医嘱集和 PSQ 评分记录流程表）。运行图跟踪进度，并生成描述性统计数据。
在该项目期间，共有 2067 名患者因哮喘加重入院。共有 1531 名患者（74%）完成了 PSQ。在筛查的患者中，360 名（24%）PSQ 呈阳性；平均年龄为 8.6 岁。在项目开始后约 14 个月，约 90%因哮喘入院的儿童都在接受筛查；随后，超过 80%的患者一直接受筛查，直至 2022 年 5 月。当常规哮喘风险筛查完成时，使用 PSQ 进行筛查的比例约为 90%。
成功实施了 SDB 筛查流程，该流程似乎切实可行且可持续。高比例的阳性筛查结果强化了在需要因哮喘加重而住院的高危人群中评估 SDB 的重要性。
