title: Changes to a pediatric sleep disordered breathing clinic improve wait-times and clinic efficiency.
abstract: Recognition of the impact of sleep disordered breathing (SDB) on health has increased referrals in pediatric respiratory medicine with a concomitant increase in wait-times.
  
  
  
  To 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.
  
  
  
  The 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.
  
  
  
  A 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. © 2016 Wiley Periodicals, Inc.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Lau
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.|Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Ewing
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Juanita
authors.initials: J
authors.lastname: Gnanapragasam
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.|Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Carina
authors.initials: C
authors.lastname: Majaesic
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.|Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Joanna
authors.initials: J
authors.lastname: MacLean
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada. mandhane@ualberta.ca.|Stollery Children's Hospital, Edmonton, Alberta, Canada. mandhane@ualberta.ca.
authors.forename: Piush J
authors.initials: PJ
authors.lastname: Mandhane
mesh_terms: D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D004526:Efficiency; D005260:Female; D006801:Humans; D008297:Male; D010092:Oximetry; D017286:Polysomnography; D012017:Referral and Consultation; D012890:Sleep; D012891:Sleep Apnea Syndromes / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: quality improvement; sleep medicine