Rapid Response Calls and Code Blue Activations relative to

Sleep Apnea Status

Dr. Tosha Allen, DNP, RN, CENJon H. Lemke, PhD

Jordan Brautigam, MSNeil Flynn

Team Sleep Apnea

Genesis Health System Research Summit: June 18, 2015

My Inspiration! Sleep Apnea affects more than 18

million Americans. Gap in Literature on cardiopulmonary

arrest and sleep apnea exist. Mostly what health risks are associated with sleep apnea disorders.

Sleeping disordered breathing is associated with health conditions across ALL organ systems.

Obstructive Sleep Apnea has been linked to cardiac arrhythmias (Roche et al. 2003).

Background

The purpose of this quantitative research is to (a) examine the relationship between

rates of rapid response, code blues and sleep apnea status and

(b) analyze the accuracy of nursing and physician documentation in regards to sleep apnea on patients who had an RRT or cardiopulmonary arrest (code blue) activation in the hospital

Purpose

Sleep Apnea and RRTs? Sleep Apnea and Code Blue?

(Cardiopulmonary arrests) Rate of Mortality? RRT and Documentation? Code Blue and Documentation?

Research Questions

Genesis Medical Center (GMC) Davenport Medical/Pulmonary Unit, Surgical Specialty Unit, Cardiovascular Interventional Unit, Cardiac Stepdown Unit, Neurology Unit, Oncology Unit, Orthopedic Unit, and Peds/Adult Surgical Unit, West ICU, and East CCU/ICU

Transitions in Personnel Restrict Rapid Response Data to:November 4, 2012-February 27, 2013; March 20, 2013-April 20, 2014; andJuly 1, 2014-November 3, 2014.

Setting

Patients have already been screened via Genesis Sleep Apnea Registry.

Logistic regression with demographics and rates

Compare RRT and Code Blue rates across sleep apnea status.

Estimate the probability of dying given sleep apnea status and alerts.

MINITAB, TIBCO Spotfire (S-Plus) or the Cytel studio for exact tests for sparse data.

Data Analysis

1101009080706050403020

1.0

0.8

0.6

0.4

0.2

0.0

Age

Prob

abili

ty

3 0 13 1 03 1 14 0 04 0 14 1 04 1 1

1 0 01 0 11 1 01 1 12 0 02 0 12 1 02 1 13 0 0

StatusApneaSleep

CB>0 RRT>0

Probability of Expiring During Stay by Age, Sleep Apnea Status,Rapid Response, and Code Blue

100806040200

1.0

0.8

0.6

0.4

0.2

0.0

Age

Prob

abili

ty

Unlikely No NoUnlikely No YesUnlikely Yes NoUnlikely Yes Yes

StatusSleep Apnea

CB>0 RRT>0

Probability of Expiring During Stay by Age, Sleep Apnea Status,Rapid Response, and Code Blue for Unlikely's

Nonadherent and Probable Sleep Apnea Patients are more likely to have Rapid Response and Code Blue Alerts.

Nonadherent and Probable Sleep Apnea Patients with Code Blue Alerts are more likely to Survive their Hospital Stay. And, Rapid Responses immediately followed by Code Blue are most predictive of death.

Further Modeling and Disease-Specific Analyses will be Required before Publishing.

With Recognition of Sleep Apnea Status one can come to expect the unexpected.

Conclusions