Changes to a pediatric sleep disordered breathing clinic improve wait-times and clinic efficiency

BackgroundRecognition of the impact of sleep disordered breathing (SDB) on health has increased referrals in pediatric respiratory medicine with a concomitant increase in wait-times. MethodsTo reduce wait-time (primary outcome), we developed a rapid SDB clinic (RSC) to identify, diagnose, and treat patients with few to no comorbidities (uncomplicated) and presumed SDB based on the referral letter. The RSC uses 1) parent-report questionnaires to capture the patients' medical history and 2) sleep testing (e.g., overnight oximetry) completed prior to the initial consultation. ResultsThe combination of pre-clinic electronic-questionnaires and testing increased patient consult capacity by 100%. Of the 256 patients referred to the RSC over 28 months, 130 patients were seen through the RSC, 17 patients were re-triaged to a standard sleep clinic (SSC) after questionnaire review, 51 patients were completing the RSC process, and 75 patients had their referral cancelled. An electronic-questionnaire RSC (n=45) reduced wait-times by 34% to 142.8 (SD 57) days compared to a paper-questionnaire RSC (P<0.001). The electronic RSC was also associated with 77.4 (SD 74.1) days reduction in wait-time (P=0.04) for SSC patients seen during the same timeframe. RSC patients were 75% less likely to require a follow-up visit (P<0.001) compared to SSC patients seen during the same timeframe. ConclusionA targeted, streamlined clinic using electronic-questionnaires for uncomplicated patients can improve wait-times for children being referred to pediatric respiratory medicine for evaluation of sleep disordered breathing. Pediatr Pulmonol. 2016;51:1234-1241. (c) 2016 Wiley Periodicals, Inc.