Assessment of factors influencing referral acceptance to a tertiary complex ventilation and specialist weaning unit

Background: Electronic referral systems improve workflow efficiency and enable systematic evaluation of referral outcomes. The Lane Fox Unit is a UK specialist weaning and complex home mechanical ventilation centre, providing level 3 (tracheostomy) and level 2 (non-invasive) ventilation services. To optimise referral processes we analysed rejection reasons. Methods: Retrospective analysis of all referrals for inpatient transfers and remote NIV set-up (October 2020-January 2024). Rejection reasons and clinical characteristics were assessed. Results: 717 referrals for 609 patients were received; median age 64 [IQR 50-72], 51% male. 250 (35%) were rejected. Rejection reasons (n=242, excluding 8 duplicates): patient requiring medical optimisation (30%), patient no longer requiring ventilation (26%), inappropriate referral (16%), insufficient information (10%), patient death (5%), inadequate care arrangements (3%), other (10%). Age and sex did not differ between groups (p=0.27, p=0.40). Patients with rejected referrals had longer pre-referral stays (median 29 vs 16 days; p