0802 Quantifying Screening Efficacy and Referral Patterns in Well Child Visits

Abstract

Abstract Introduction Sleep-disordered breathing (SDB) can have profound impacts on pediatric physical, psychological and behavioral health. However, proactive history taking is needed to identify the signs of SDB, such as snoring. The American Academy of Pediatrics (AAP) therefore recommends that primary care providers actively screen for snoring at routine health maintenance visits. This study aims to assess the use of a snoring screening tool in our institution’s Electronic Medical Record (EMR) well child visit templates and subsequent rate of screening for sleep disordered breathing during routine pediatric visits. Methods We queried our institution’s electronic medical record for all patients ages 0-17 years who were presenting for their Well Child Visit (WCV) from January 1, 2019 through September 30, 2022. The query yielded a convenience sample of 428,632 children. The question “does your child snore” was embedded into the WCV template for all primary care providers. Results Before the pandemic only 12.3% of WCVs (52,695 patients) had a completed screening question. The snoring prevalence was 6.4% (4,034 patients) with 15% (594 patients) of those who screened positive for snoring receiving a referral to ENT or sleep medicine (65% to ENT). During the COVID pandemic (2020-2021) the screening rate was 13.4%. The snoring prevalence was 5.2% with 19% being referred to ENT or sleep medicine. There was also an increase in screening during the COVID pandemic, but screening usage reverted to pre-COVID levels when pandemic restrictions eased in 2022. Conclusion The introduction of a snoring screening tool in generic WCV note templates did not significantly improve the rate of screening for sleep disordered breathing at routine pediatric visits. However, this embedded tool was used more often during the SARS-CoV2 pandemic, when many visits were performed using telemedicine. Our data collection also highlighted a high prevalence of snoring within our institution and a referral pattern that largely routes these children directly to Otolaryngology versus Pediatric Sleep Medicine. This makes it imperative to continue brainstorming ways to support primary providers' abilities to screen for SDB and empower them with management options. Support (if any) None