NR 730 Week 6 Results Write-Up Example

Results: Twelve Weeks of Sleep Apnea Screening and a Pathway for High Scorers in a Same-Day Surgery Center, 3 March to 26 May 2027

Student Name

College of Nursing, Chamberlain University

NR 730: DNP Project

Instructor Name

Month Day, Year

Results: Twelve Weeks of Sleep Apnea Screening and a Pathway for High Scorers in a Same-Day Surgery Center, 3 March to 26 May 2027

Patient Flow

Between 3 March and 26 May 2027, 1,742 adults were scheduled for procedures under general anesthesia or sedation at the center. Forty-four were canceled or rescheduled outside the window, leaving 1,698 adults who had eligible procedures. Of these, 1,529 had a finished STOP-Bang score by the time they reached the operating room, and 169 did not. Of the 169, 112 had the questionnaire items completed by phone but no neck measurement recorded on admission, and 57 were not reached by phone and were not screened on admission. Of the 1,529 screened adults, 213 scored 5 or more, 412 scored 3 or 4 and 904 scored 0 to 2.

Missing Data

Three gaps in the data are reported before the results. The 169 unscreened adults are included in all outcome denominators and reported as a separate group. Four recovery event log entries lacked a time stamp and were counted as events because the event itself was documented. Recovery length of stay could not be calculated for 9 adults whose discharge time was not recorded; they are excluded from the length-of-stay medians only.

Results, in the Order the Plan Promised

Table 1

Project Measures, Baseline and Twelve-Week Results

Note. Note. Baseline from the center's quality records. Confidence intervals are normal approximations. Length of stay excludes 9 adults with missing discharge times.

Measure 1: Screening Completion

Weekly screening completion was 71% and 74% in the first two weeks, then between 88% and 95% in each of the ten weeks after neck measurement moved to admission on 17 March. The run chart shows a shift beginning in week 3, with every subsequent week above the median of the first two, which meets the standard run chart rule for a shift (Provost & Murray, 2022). Across the twelve weeks, 1,529 of 1,698 adults were screened, 90.0%, meeting the target of 90%.

Table 2

Weekly Screening Completion, 3 March to 26 May 2027

Note. Note. Neck measurement moved from the phone call to admission on 17 March, during week 3.

Measure 2: Pathway Delivery

Of the 213 high-risk adults, 184, 86.4%, received all four pathway elements, meeting the target of 85%. By element, the score was complete before surgery for all 213 by definition, anesthesia notification was documented for 198, 93.0%, the opioid-sparing order set was used without override for 196, 92.0%, and extended recovery monitoring was documented for 201, 94.4%.

Measure 3: Recovery Respiratory Events

Respiratory events in recovery occurred in 66 of 1,698 adults, 3.9%, compared with 140 of 3,412, 4.1%, in the baseline period. The confidence intervals overlap almost entirely; the overall rate did not change. By score band, events occurred in 19 of 213 high-risk adults, 8.9%, 22 of 412 intermediate-risk adults, 5.3%, 18 of 904 low-risk adults, 2.0%, and 7 of 169 unscreened adults, 4.1%.

Table 3

Recovery Respiratory Events by STOP-Bang Score Band

Note. Note. Event definition from the recovery event log; four entries without time stamps counted as events.

Measure 4: Unplanned Transfers

Twelve adults, 0.7%, were transferred or admitted, compared with 21, 0.6%, in the baseline period. Three of the twelve were attributed in the transfer log to respiratory causes, compared with 6 of 21 at baseline.

Measure 5: Recovery Length of Stay

The median recovery stay was 67 minutes for all adults, against a baseline of 64. Broken down by score band, the median was 94 minutes for high-risk adults, 68 minutes for intermediate-risk adults and 61 minutes for low-risk adults.

Measure 6: Order Set Overrides

The opioid-sparing order set was overridden for 17 of 213 high-risk adults, 8.0%. In 12 of the 17, the documented reason was a procedure expected to cause pain that the non-opioid regimen would not cover; the other 5 overrides had no reason recorded.

Measure 7: Primary Care Letters

Letters recommending sleep evaluation were sent within two business days for 197 of 213 high-risk adults, 92.5%; the remaining 16 were sent later, all within seven days of the procedure date.

Follow-Up After Discharge

The center's routine next-day call reached 171 of the 213 high-risk adults. None of those reached reported a breathing problem overnight that required emergency care; 9 reported unusual sleepiness, and each was advised according to the center's existing call protocol. At a 30-day follow-up call, added for this project, 154 of the 213 were reached; 38 of the 154, 24.7%, reported that a sleep evaluation had been scheduled or completed, 61 reported that their clinician had not yet discussed it and 55 said they did not plan to pursue it. These figures are self-reported by patients and were not checked against any other record.

Agreement Check

In the monthly agreement checks, the quality coordinator's chart review agreed with the charge nurse's audit on all four elements for 14 of 15 sampled patients; the one disagreement concerned monitoring documentation and was corrected in the week it occurred. These results are reported following the structure recommended for improvement reports, with flow, measures and missing data described separately (Ogrinc et al., 2016), and the score bands use the questionnaire's published categories (Chung et al., 2016).

References

Chung, F., Abdullah, H. R., & Liao, P. (2016). STOP-Bang questionnaire: A practical approach to screen for obstructive sleep apnea. Chest, 149(3), 631-638. https://doi.org/10.1378/chest.15-0903

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Provost, L. P., & Murray, S. K. (2022). The health care data guide: Learning from data for improvement (2nd ed.). Jossey-Bass.