0849 Characterization of Patient Referrals to ED/Inpatient Admission from an Outpatient Pediatric Sleep Center

Abstract Introduction The medical complexity of patients referred to our pediatric laboratory has been increasing. These children are at higher risk of severe sleep disordered breathing and/or risk of emergent medical issues during the study. As a result, patients may need to be referred directly to emergency room or inpatient admission from the ambulatory sleep lab. In this single site pediatric sleep lab quality improvement project, we identify the frequency of ED/inpatient referrals from attended, in-lab sleep studies, reasons for referrals, and contributing factors for referral. Methods This is a cohort study of patients who had in-lab ambulatory polysomnogram at Boston Children’s Hospital between March 2017 to May 2022 identified through chart review search terms (ED or inpatient diagnostic codes within 24 hours of polysomnogram billing code). We performed chart review for demographics, past medical history, sleep study variables, medications, and disposition. We used chi-square tests to compare age and medical complexity categories. Results Of 6724 PSG studies conducted, 95 (1.4%) patients were referred to ED or inpatient admission within 24 hours from the sleep study. Demographics: Patients ranged in age from 1 month to 20 years [mean age 5.5(6) years] and the cohort was 38% female, 53% Caucasian, 12% Black, 2% Asian, 13% Hispanic, 6% other, 14% race/ethnicity not reported. Of the 95 patients referred to ED/inpatient hospitalization, 64% needed continued medical assistance in the morning due to various problems including persistent hypoxia, hypercarbia, altered mental status, difficulty tolerating oral intake, or need for assistance ambulating. Features such as age and patient triage level assigned prior to sleep study did not predict whether patient returned to baseline upon wakening. The reason for referral for ED or admission included severe sleep disordered breathing (e.g. obstructive sleep apnea or central sleep apnea; 33.8%), persistent hypoxia/hypercarbia (23.1%), cardiac (e.g. arrhythmias, worsening heart disease; 10.8%), vomiting/diarrhea (10.8%), neurologic (e.g. seizures, paroxysmal events, altered mental status; 7.7%), infection (e.g. fever/infection concern; 3.1%), allergy/anaphylaxis (1.5%), behavioral/psychiatric (1.5%), and metabolic derangements (e.g. hypoglycemia; 1%). Conclusion This quality improvement project informs sleep lab policies and procedures regarding staffing, training and management of urgent medical issues that arise during pediatric sleep studies. Support (if any) None