Reducing referral-to-consultation delays in pediatric obstructive sleep apnea through standardized triage: A regional quality improvement initiative.

BACKGROUND

Timely management of pediatric obstructive sleep apnea (OSA) is essential to prevent sequelae. In publicly funded health systems, delays remain common, particularly in non-urban regions with limited specialty capacity. At a regional hospital serving Québec's Bas-Saint-Laurent region, prolonged wait times for adenotonsillectomy were observed. Preliminary review identified referral-to-consultation delay (Wait-1) as the principal access bottleneck, exceeding Pediatric Canadian Access Targets for Surgery.

METHODS

Using SQUIRE 2.0 guidelines, we conducted a quality improvement initiative. A retrospective analysis of consecutive pediatric patients undergoing adenotonsillectomy for sleep-disordered breathing over 22 months (n = 82) quantified referral-to-consultation (Wait-1), consultation-to-surgery (Wait-2), and total referral-to-surgery delays. Age, tonsil grade, oxygen desaturation index, and McGill Oximetry Score were assessed as predictors of delay. Multivariable regression identified clinical predictors of management timing. Process mapping and root cause analysis identified non-standardized referral triage as the primary modifiable factor. A standardized referral template and severity-based triage algorithm incorporating tonsil grade, Pediatric Sleep Questionnaire, and oximetry findings were developed. Implementation through Plan-Do-Study-Act cycles is planned but not reported here.

RESULTS

Mean Wait-1 was 9.0 ± 7.0 months, Wait-2 was 6.2 ± 3.6 months, and total referral-to-surgery delay was 15.2 ± 8.6 months. Higher tonsil grade (p = 0.015) and oxygen desaturation index (p = 0.032) predicted shorter Wait-2. Oxygen desaturation index independently predicted shorter Wait-1 (p = 0.023) and total delay (p = 0.008). While Wait-2 met Pediatric Canadian Access Targets for Surgery for mild OSA, Wait-1 substantially exceeded benchmarks.

CONCLUSIONS

In this non-urban setting, access delays occur primarily before specialty consultation. Standardized referral triage using objective severity markers may improve prioritization and alignment with national benchmarks.