Improving Postoperative Care for Veterans With Obstructive Sleep Apnea Through Preoperative Education and the Electronic Health Record: A Quality Improvement Project

Purpose: The purpose of this quality improvement (QI) project was to establish and evaluate a process to improve use of positive airway pressure (PAP) therapy on the day of surgery, postoperative day 0 (POD 0), for Veterans using home PAP therapy for obstructive sleep apnea (OSA) admitted to the hospital after surgery.

Design: QI project using a preimplementation and postimplementation design.

Methods: The QI project occurred from June 2023 through November 2023. Nurses added written and verbal preoperative patient education for Veterans with OSA to bring their home PAP equipment on the day of surgery, and a new dedicated continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) inpatient respiratory therapy consult was added in the electronic health record surgery admission order sets.

Findings: From June 2023 through August 2023, 42 Veterans met criteria in the preimplementation group, and from September 2023 through November 2023, 50 Veterans met criteria in the postimplementation group. After project initiation, 97.8% of eligible Veterans received preoperative education, and the number of Veterans bringing PAP equipment on the day of surgery increased from 9.5% to 62% (P < .001). Respiratory therapy consults for PAP set-up on POD 0 increased from 26.2% to 36.0% (P = .371), and 28% of Veterans in the post implementation group had CPAP or BiPAP inpatient respiratory therapy consults ordered on POD 0.

Conclusions: Preoperative nursing patient education resulted in a statistically significant increase in Veterans bringing home PAP equipment on the day of surgery, while adding a CPAP or BiPAP inpatient respiratory therapy consult to the electronic health record did not result in a statistically significant improvement in surgical residents ordering PAP therapy on POD 0. This QI project revealed how interventions that incur nominal cost and have minimal impact on preoperative nursing education workflow can yield statistically significant compliance. Additional research is needed to develop and implement a standardized protocol in all Veterans Affairs (VA) facilities to optimize postoperative care for Veterans diagnosed with OSA undergoing surgery.