0940 Implementation of the BEARS Screening Tool Within the Pediatric Resident Continuity Clinic Setting in Improving Referrals to Pediatric Sleep Medicine

Abstract Introduction The prevalence of parent-defined sleep problems in various sleep domains ranges from 9.3 to 45.6%, with 67.9% of children having significant problems in at least one sleep domain. The most common problems reported were bedtime resistance and parasomnias. Despite this high prevalence of pediatric sleep problems observed within the primary care, rates of screening and referrals to sleep medicine are low. Our aim was to implement a simple 5- item pediatric sleep screening instrument-the BEARS sleep screening tool-within a pediatric resident continuity clinic setting and seeing if this assists in both the increased detection of sleep disorders, and in appropriate referral to the Pediatric Sleep Medicine clinic. Methods Pre and Post intervention QI initiative utilizing a PDSA cycle over 5 months, among a convenience sample of 2–18-year-old well child visits. Pre/post intervention data collected by individual chart review in assessing documented sleep concerns, therapeutic interventions and Sleep Medicine Clinic referrals. BEARS forms were administered during post-intervention period. Results During the pre-intervention period, 231 patients were seen (mean age 9.25 years, median 9 years; 49.8% female, 50.2% male), with the majority identifying as Hispanic/Latino (63.2%), followed by Puerto Rican (13.9%), African American (1.7%), and others (20.3%). No screening tools were used, and only few sleep concerns were identified. After introducing the BEARS tool, 25 patients who have completed the screening tool were identified (mean age 8.52 years, median 6 years; 48% female, 52% male), with ethnicity distributed as Hispanic/Latino (36%), Puerto Rican (16%), African American (12%), White/Caucasian (16%), and others (20%). Within this sample, sleep-related issues were identified in 56% of patients. This was associated with an increase in both, referrals to sleep medicine, 5.6% to 20%, and in scheduled sleep studies, from 0.9% to 8%. Conclusion This is an ongoing QI project, with observed results to- date being limited due to small sample size. Nevertheless, these findings demonstrate that integrating the BEARS tool may greatly increase screening for sleep disorders, referrals to Sleep Medicine clinic, and institution of appropriate treatments, for pediatric patients across various demographic groups. Support (if any)