ArticleBMJ quality & safety2021
Nurse-led triage of new sleep referrals is associated with lower risk of potentially contraindicated sleep testing: a retrospective cohort study.
Article in BMJ quality & safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
5 citing papers in PubMed, 11 citations in OpenAlex.
- Barriers and Facilitators to Cross-Institutional Referrals: System Configuration Analysis of VA Staff Experiences.Journal of general internal medicine · 2025Article
- Receipt of Weight Management Services Among Patients With OSA and Obesity.CHEST pulmonary · 2025Article
- Clinical recommendations for telehealth and electronic consultations in the veterans health administration referral coordination initiative.American heart journal plus : cardiology research and practice · 2025Article
- The effects of the Veterans Health Administration's Referral Coordination Initiative on referral patterns and waiting times for specialty care.Health services research · 2024Article
- The value of nurse-led anthropometric and oropharyngeal measurements combined with STOP-Bang questionnaire in screening for obstructive sleep apnea in patients with acute coronary syndrome: a prospective cohort study.BMC pulmonary medicine · 2022Observational
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Authors and funding
13 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundThe 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.
objectiveWithin 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).
methodsPatients 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.
resultsRCS 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).
conclusionOur results suggest that incorporating registered nurses into triage decision-making may improve the quality of diagnostic care for OSA.
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