{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T22:00:01Z","timestamp":1773957601387,"version":"3.50.1"},"reference-count":26,"publisher":"BMJ","issue":"7","funder":[{"name":"VA Office of Veterans Access to Care"},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["Career Development Award, CDA-18-187"],"award-info":[{"award-number":["Career Development Award, CDA-18-187"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2020,12,1]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"\n Background<\/jats:title>\n The volume of specialty care referrals often outstrips specialists\u2019 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\u2019 triage decisions to ensure such management is safe.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Our results suggest that incorporating registered nurses into triage decision-making may improve the quality of diagnostic care for OSA.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjqs-2020-011817","type":"journal-article","created":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T13:27:22Z","timestamp":1608730042000},"page":"599-607","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Nurse-led triage of new sleep referrals is associated with lower risk of potentially contraindicated sleep testing: a retrospective cohort study"],"prefix":"10.1136","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8187-2641","authenticated-orcid":false,"given":"Lucas M","family":"Donovan","sequence":"first","affiliation":[{"name":"Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA"},{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian N","family":"Palen","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adnan","family":"Syed","sequence":"additional","affiliation":[{"name":"VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Blankenhorn","sequence":"additional","affiliation":[{"name":"VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Blanchard","sequence":"additional","affiliation":[{"name":"VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William J","family":"Feser","sequence":"additional","affiliation":[{"name":"VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Magid","sequence":"additional","affiliation":[{"name":"VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justina","family":"Gamache","sequence":"additional","affiliation":[{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1269-5298","authenticated-orcid":false,"given":"Laura J","family":"Spece","sequence":"additional","affiliation":[{"name":"Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA"},{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura C","family":"Feemster","sequence":"additional","affiliation":[{"name":"Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA"},{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurie","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Office of Community Care, VISN 20, Vancouver, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Kirsh","sequence":"additional","affiliation":[{"name":"Office of Veterans Access to Care, Department of Veterans Affairs, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David H","family":"Au","sequence":"additional","affiliation":[{"name":"Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA"},{"name":"Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,22]]},"reference":[{"key":"2025090412065466000_30.7.599.1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.722"},{"key":"2025090412065466000_30.7.599.2","unstructured":"Department of Veterans Affairs Office of Inspector General . 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