1229 Interventions to Reduce Loss of HSAT (Home Sleep Apnea Testing) Devices and Associated Costs: A Continuous Improvement Initiative

Abstract Introduction Home Sleep Apnea Testing(HSAT) programs rely on high-cost diagnostic devices that are vulnerable to loss, leading to substantial replacement costs and operational inefficiencies. Although health systems are already optimizing HSAT logistics, these interventions are largely structural(delivery, prioritization and insurance processing) and rarely focus on inventory management and the financial burden on non-return. HSAT is treated as a modality with a per-test cost, not as a loaned device with a measurable loss-rate and has not yet been modelled as its own economic problem. We implemented a series of workflow and logistics interventions to reduce HSAT device loss, evaluate associated cost savings and improve device cycle time. Methods At the Cleveland Clinic's Sleep Disorder Center, we conducted a continuous-improvement initiative targeting HSAT device retention from January 2025 through September 2025. Sequential interventions included: (1) Billing list workflow with daily patient reminder phone calls for outstanding devices, (2) an apartment delivery workflow requiring signatures upon receipt, (3) 2week billing policy to prompt timely returns, (4) Real-time device location tracking using Air-Tags, and (5) Courier route optimization to improve pick-up/drop-off. We compared average monthly billed-unreturned devices and estimated cost savings before and after implementation of the bundled interventions. Results Devices billed as unreturned decreased from 46 in 2023 (3.8/month) and 39 in 2024 (3.3/month) to 10 between January and September 2025 (1.1/month). 20 devices were “saved,” corresponding to approximately $65,000 in avoided YTD replacement costs (devices valued $3,250 each). As a direct result of these interventions, the average device use-rate increased from 1.6 to 3.3 uses per device per week effectively doubling our capacity to conduct HSATs thus improving access. Conclusion The literature is rich with HSAT implementation-oriented projects that focus on workflows and improving accessibility to care, but device return is always assumed rather than measured. To our knowledge, this was the first explicit attempt to quantify and optimize HSAT device inventory. A multipronged, implementation-focused HSAT workflow was associated with a substantial reduction in billed-unreturned HSAT devices and associated cost savings. These findings suggest that relatively low-cost operational interventions can significantly improve device retention in HSAT programs and may be generalizable to other home-based diagnostic modalities. Support (if any)