P73 Implementation of a computer guided consultation (intelligent clinical decision support system software) in the Liverpool sleep service: the creation of a digital ecosystem to transform patient pathways

BackgroundThe Liverpool Sleep Centre provides secondary/tertiary level care for a range of sleep disorders. An increasing volume of referrals and the impact of Covid threatened to overwhelm the service resulting in increasing clinical risk and decreased patient satisfaction. We describe how the use of technology addressed these challenges through the implementation of a Computer Guided Consultation system i.e. clinical decision support software (CDSS).MethodologyThe CDSS is a digital ecosystem comprising multiple intelligent consultations encompassing the entire OSA pathway including Assessment and diagnosis, CPAP set up, CPAP monitoring and issuing consumables thus acting as an end to end system solution and an Electronic Patient Record. The CDSS also features a ‘clinical dashboard’ allowing the service to track activity, monitor RTT performance and identify high risk patients e.g. sleepy drivers, hypoventilation in ‘real time’.ResultsPrior to implementation of the CDSS, all suspected OSA referrals underwent a sleep study and the results of which together with the information contained in the referral letter would have been reviewed by a Consultant in a ‘Virtual clinic’ with treatment decisions made in such clinics. In order to meet this demand, the service required 8 clinics weekly (5 Consultant ‘Virtual’ clinics consisting of 20 patients each and 3 ‘Combined’ Consultant/Physiologist clinics). Since March 1st to June 2021 following CDSS implementation, 325 patients (see table 1 for demographics) with suspected OSA were assessed by paramedical staff using the CDSS. Only 15% of these patients subsequently required a Consultant review either in a ‘Virtual’ or a ‘Face to Face’ manner (translating into just 0.5 clinics weekly), no ‘combined’ clinics were required with the ‘clinical dashboard’ used to highlight difficult cases for a weekly MDT. The CDSS generates automated clinical letters for each review thus greatly reducing secretarial time/costs for the service as no typing is required.Abstract P73 Table 1Demographics of study population (n=325)Age (mean SD) 49 (14) Gender 48% female BMI 35.9 (9.3) AHI (valid sleep study at time of analysis in 282) 18.7 (19.6) ESS 10.5 Diagnostic breakdown Mild OSA (21%); Mod OSA (18%); Severe OSA (22%); Other (39%) ConclusionThe implementation of an intelligent Computer Guided Consultation system has resulted in pathway transformation enabling scarce Consultant resource to be channelled to where it is most required and en