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P36 Improving processes for inpatients referrals to the sleep service implementing an electronic referral system in Wrightington, Wigan and Leigh Teaching Hospital NHS Foundation Trust
  1. Lisa Butler and
  2. Nyuk Cho Lee
  1. Wrightington, Wigan and Leigh teaching hospitals NHS foundation Trust, Leigh, UK


Introduction The health implications of sleep disordered breathing and its associated cardiovascular co-morbidities are increasingly recognised. However, the sleep specialist was not always made aware of these patients when they were admitted to hospital. NICE guidelines1 acknowledge the need for urgent access and rapid assessment. We aim to change current referral process with the designing of an electronic system, to identify patients who are needing inpatient specialist input with the right referral process.

Methods A literature review was conducted to strengthen evidence. A Baseline Audit of current clinical practice to measure shortfalls and gaps, identifying referral numbers and missed opportunities. We reviewed patients admitted in a three-month period from April to Jun 2021, coded with Obstructive Sleep Apnoea and Obesity Hypoventilation. Internal referrals were analysed identifying route type and quality of referral. Pre staff questionnaires were used to engage with the wider team gaining their perspective and to obtain qualitative data.

Results There were 373 patients coded but 287 excluded for day cases and being under other services. Hence, only 86 patients were analysed.

59% had not used CPAP whilst in hospital. Only 11% of target group were referred to the service, with 89% potential referrals missed (table 1).

Current process showed main referral route to be emailed (65%).71% were of poor quality and 15% were duplicated (table 2). 88% of Pre staff questionnaires agreed e-referral would be beneficial.

Abstract P36 Table 1
Abstract P36 Table 2

Discussion This audit provided a deeper understanding, highlighted the inefficiencies, and supported a referral process improvement through electronic method. This was addressed successfully by implementing a new electronic referral process. We need to evaluate the effectiveness with a repeat audit.


  1. National Institute for Health and Care Excellence (NICE). (2021) Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s. (NICE guideline 202). [online] Available from:

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