RT Journal Article SR Electronic T1 Nurse-led triage of new sleep referrals is associated with lower risk of potentially contraindicated sleep testing: a retrospective cohort study JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 599 OP 607 DO 10.1136/bmjqs-2020-011817 VO 30 IS 7 A1 Lucas M Donovan A1 Brian N Palen A1 Adnan Syed A1 Richard Blankenhorn A1 Kelly Blanchard A1 William J Feser A1 Kate Magid A1 Justina Gamache A1 Laura J Spece A1 Laura C Feemster A1 Laurie Fernandes A1 Susan Kirsh A1 David H Au YR 2021 UL http://qualitysafety.bmj.com/content/30/7/599.abstract AB Background The volume of specialty care referrals often outstrips specialists’ capacity. The Department of Veterans Affairs launched a system of referral coordination to augment our workforce, empowering registered nurses to use decision support tools to triage specialty referrals. While task shifting may improve access, there is limited evidence regarding the relative quality of nurses’ triage decisions to ensure such management is safe.Objective Within the specialty of sleep medicine, we compared receipt of contraindicated testing for obstructive sleep apnoea (OSA) between patients triaged to sleep testing by nurses in the referral coordination system (RCS) relative to our traditional specialist-led system (TSS).Methods Patients referred for OSA evaluation can be triaged to either home sleep apnoea testing (HSAT) or polysomnography, and existing guidelines specify patients for whom HSAT is contraindicated. In RCS, nurses used a decision support tool to make triage decisions for sleep testing but were instructed to seek specialist oversight in complex cases. In TSS, specialists made triage decisions themselves. We performed a single-centre retrospective cohort study of patients without OSA who were referred to sleep testing between September 2018 and August 2019. Patients were assigned to triage by RCS or TSS in quasirandom fashion based on triager availability at time of referral. We compared receipt of contraindicated sleep tests between groups using a generalised linear model adjusted for day of the week and time of day of referral.Results RCS triaged 793 referrals for OSA evaluation relative to 1787 by TSS. Patients with RCS triages were at lower risk of receiving potentially contraindicated sleep tests relative risk 0.52 (95% CI 0.29 to 0.93).Conclusion Our results suggest that incorporating registered nurses into triage decision-making may improve the quality of diagnostic care for OSA.Data are available upon reasonable request. Approval of the VA Collaborative Evaluation Center and VA Office of Veterans Access to Care is required prior to the sharing of data for this project.