Overview
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder worldwide, affecting up to 936 million people. It is highly prevalent in China, the US, Brazil and India, yet remains grossly underdiagnosed. Because OSA increases morbidity and mortality, its presence in surgical patients poses significant risks — particularly as more procedures, such as total joint arthroplasty, shift to the outpatient setting.
The challenge: Implementing an evidence-based quality improvement project
At a midwestern community hospital in the US, many patients presenting for outpatient total joint surgery were not being screened or treated for OSA. This gap exposed them to a higher risk of airway, cardiovascular, and pulmonary complications post-operatively. The project team — comprised of DNP nurse anaesthesiology students, nurse navigators, and quality improvement leaders — recognised the need for an evidence-based protocol for early screening, detection, and referral.
Evidence-based approach to patient safety
International guidelines, including a JBI Best Practice Evidence (2021, updated 2023), recommend routine peri-operative screening for OSA using validated tools such as the STOP-Bang questionnaire, with appropriate referral for sleep study and continuation of CPAP therapy. Drawing on these recommendations and the JBI Evidence Implementation Framework, the team designed an evidence-based practice project to close the screening gap.
