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THE CDHB SLEEP SERVICE
CHRISTCHURCH HOSPITAL • 1 Manager • 2 Sleep Nurse Specialists • 3 Sleep Doctors • 6 Sleep Physiologists • 2 Administra=on BURWOOD HOSPITAL • Spinal Nurse Specialist • Doctors (Spinal, Brain Injury) ASHBURTON HOSPITAL • Sleep Doctor • Registered Nurse • Clinical Physiologist COMMUNITY SERVICES • Approved prac=ces (prac=ce nurse + GP) • 3 Nurse facilitators • 3 Clinical Nurse Specialists (WC) • 2 Clinical Nurse Specialists (SC)
What do the Sleep Unit do?
Sleep Unit
Diagnos=c Tests
Educa=on
Clinical Review
Treatment
Sleep Unit
In-‐pa=ent referral
Sleep Pathway
Private Referral
CPAP Trial
BiPAP Trial
ASV Trial
Sleep Study
Sleep Doctor
Sleep Unit
Sleep Pathway
CPAP Trial
Community Pathway for Hospital CPAP Care
Symptoms
GP
Sleep Assessment
Sleep Unit
OSA Sleep Pathway
Case reviewed MDT
Qualify for CPAP
Trial CPAP Therapy
Go onto Long Term
CPAP Treatment
CDHB CPAP GROWTH (new paGents to CPAP)
WHY DO WE TREAT OSA?
• Contribu=ng Co-‐morbidi=es • Motor vehicle accidents • Work related accidents • Impaired work performance • Social embarrassment • Marital problems • Memory and concentra=on difficul=es • Depression • Impaired quality of life
1. Are PaGents Using Therapy? (n=70)
• Mean Objec=ve Compliance: • 5 ± 2 days per week • 5:40 ± 2:04 hours per used day
• 70% met criteria of 5/7, 5/24 • 20% sub-‐op=mal • 10% not using
Mr EE 75 YO
SpO2
SpO2
Time (hours)
Time (hours)
Diagnos=c study: ODI 43.0 per hour
CPAP 12 cm H2O : ODI 0.7 per hour
2. Does CPAP Work? (ObjecGve)
2. Does CPAP Work? (ObjecGve)
0
10
20
30
40
50
60
70
Pre ODI Post CPAP ODI
ODI
p<0.0001 n=85 paired data
Normal
3. Does CPAP Work (SubjecGve)?
-‐1
4
9
14
19
24
Pre CPAP ESS End Trial ESS Current ESS
ESS
n=92 paired data p<0.0001 p=0.1064
p<0.0001
Moderate
Severe
4. Are PaGents SaGsfied?
• 90% sa=sfac=on with service • 80% happy with loca=on of clinic • 66% wanted more wrieen informa=on
• Focus group for individualised responses
120 pa=ents audited 57% response rate
Where are we now, where are we going?
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
2013 2014 2015 2016 2017 2018
Total patients to CPAP
Year
Qualifies for Hospital
Funded CPAP CPAP Trial Pa=ent on Long
Term CPAP
Current CDHB CPAP Model
CPAP Review Replacement parts
Capacity
Qualifies for Hospital
Funded CPAP CPAP Trial Pa=ent on Long
Term CPAP
Current CDHB CPAP Model
CPAP Review Replacement parts
Qualifies for Hospital
Funded CPAP CPAP Trial Pa=ent on Long
Term CPAP
Current CDHB CPAP Model
Future CDHB CPAP Model
Qualifies for Hospital
Funded CPAP CPAP Trial Pa=ent on Long
Term CPAP
Future CDHB CPAP Model
Capacity
Complex Pa=ents
Community Model
Review Replacement parts
For Hospital Based CPAP PaGents
There will be a change in the CPAP model of care: 1. Easier, more convenient for pa=ents 2. Improved access 3. Beeer use of resources for complex pa=ents
Thorough communica=on prior to any change
Implementa=on phase
Un=l then, if you have issues with CPAP, contact the Sleep Unit (03 364 1089); [email protected]
