Sleep disordered breathing (SDB)is under-recognized and associated with significant morbidity and mortality. Causes other than Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome include hypothyroidism, heart failure, and chronic lung diseases. The aim of this project is to assess if internal medicine residents are aware of the need to screen SDB patients for these disorders as part of the initial workup, and whether an educational intervention would be effective in altering this pattern of behavior.
A 6-week chart review was performed of housestaff pulmonary clinic notes for the initial evaluation of patients with suspected or confirmed SDB. In particular, it was noted if the physician ordered a screening thyroid stimulating hormone (TSH), pulmonary function test (PFT), and echocardiogram in their assessment and plan. Reasons for not screening were then queried. An educational intervention was subsequently given to the housestaff in the form of lectures, handouts, and a SDB progress note template. The effectiveness of the intervention was then assessed by a 6-week chart review thereafter.
36 notes were evaluated prior to the intervention. Of these, 6 (17%) physicians ordered a TSH, 11 (31%) physicians ordered a PFT, and 8 (22%) physicians ordered an echocardiogram. At followup, the most common reason for missing tests was lack of physician awareness. After an educational intervention was implemented, 29 new notes were then evaluated. Of these 17 physicians, (59%) ordered a TSH, 23 (79%) ordered a PFT, and 13 (45%) ordered an echocardiogram. The most common reasons given for missing tests were either forgetting or lack of awareness.
Our data demonstrates that educational intervention increases screening of TSH, PFT, and echocardiogram in the initial management of newly-diagnosed SDB patients, but it is not 100% effective in altering patterns of behavior.
Graduating internal medicine residents may not be fully conversant with the spectrum of SDB, even after specific educational intervention. Given the prevalence and impact of this disorder on multiple other co-morbidities, further investigation on alternative teaching methods is warranted.
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