Nurse Co-ordinated Sleep Study

Current Project

This page introduces you to the Nurse Co-ordinated Sleep Study Project

Introduction

The Nurse Co-ordinated Sleep Study pilot project is funded by the Ministry of Health's Improving Patient Pathways - Diagnostics Fund. Our project is one of fourteen funded around the country.

The aim of the project is to create a new pathway for GPs to access Level 4 Sleep Study directly from WCDHB's Respiratory Nurse Specialists. In the past Level 4 Sleep Study was only available from the Christchurch Hospital Sleep Disorders Unit following referral to the visiting Respiratory Physician.

What is Level 4 Sleep Study and why is it important?

Level 4 Sleep Study, or Overnight Home Oximetry is used to find out how much oxygen your blood is carrying to the brain and body during sleep. The patient is given a pulse oximeter to monitor sleep and breathing patterns overnight at home.

Before sleep the patient places a probe on their finger. The probe uses red and infrared light to determine how much oxygen the blood is carrying. After sleep, information from the oximeter is downloaded and analysed to identify whether the patient may have sleep disordered breathing.

If high levels of oxygen are not sustained during sleep the patient may have Obstructive Sleep Apnoea (OSA) or other sleep disorders. Patients with unmanaged OSA experience excessive daytime sleepiness, impaired neurocognitive functioning, and increased risk of motor vehicle accidents and cardiovascular disease.

Why is a new pathway needed?

A key component in diagnosis of sleep disordered breathing and OSA is the information provided by Level 4 Sleep Study. Until now, access to this study and follow-up on results has been limited for West Coast patients.

In the past, patients were referred to Grey Hospital's visiting Respiratory Physician, who would often see the patient in clinic before requesting a sleep study from the Christchurch Hospital Sleep Disorders Unit. Following a study, patients needed to see the Respiratory Physician again or the visiting Sleep Nurse Specialist in clinic for management advice.

This process could take many months as there is high demand for Overnight Oximetry at the Sleep Unit and visiting Respiratory and sleep clinics are held on the West Coast only a few times a year. Some patients waited a year or more before receiving treatment.

The new pathway sees patients referred directly to WCDHB's Respiratory Nurses, who arrange studies with equipment available on the West Coast. The Nurses assess the patient and interpret data following the study in the same way the Christchurch Sleep Unit would. Results and information from Nurse assessments are then sent to the Respiratory Physician in Christchurch, who provides advice immediately instead of waiting until the next clinic visit. It is expected this new process will cut the amount of time between referral and management of sleep disordered breathing to around three or four months.

Results

The Ministry of Health pilot phase for the project completed on 31 December 2008. The final pilot report prepared for the Ministry of Health is available at the link below.

At the beginning of the pilot nearly 50 West Coast patients were waiting for a Level 4 Sleep Study, some waiting for almost four years. The average waiting time for Level 4 Sleep Study prior to the pilot was around 600 days.

By the end of the pilot the longest wait for a study was 97 days - just over three months! At pilot conclusion on 31 December 2008 the cumulative average waiting time from referral to study was 46 days and from referral to diagnosis, 54 days. This is an incredible improvement on the service previously provided.