Imperial College Healthcare NHS Trust redesigned its obstructive sleep apnoea (OSA) diagnostic pathway, replacing a slow, plastic-heavy, multi-appointment hospital model with a digitally enabled, postal home-testing service.

Patients previously made at least 3 hospital trips to collect and return bulky equipment. Now, a small reusable wearable device is posted directly to patients, who sleep at home with it and return it the next day. A smartphone instruction video supports completion and improves health equity.

The redesigned pathway:

• eliminated 3 hospital journeys per patient, saving an estimated 4.20 kg of carbon dioxide equivalent per patient — around 12.6 tonnes annually
• reduced plastic waste by 99%, from 100g to 0.36g per test
• cut median time to diagnosis from 352 days to below 135 days
• released over 1,500 specialist hours annually through automated reporting
• reduced the outpatient waiting list from over 3,000 to below 1,000

Patients saved up to 82 minutes of travel time and up to £7.15 in out-of-pocket costs per test. The pathway also reached a higher proportion of patients from non-white ethnic backgrounds, supporting more equitable access to diagnosis.

The pathway is now embedded as routine care in Imperial College Healthcare NHS Trust and has been shared with 5 other NHS regions, including paediatric and learning disability services.

Winner of the Sustainable Healthcare award at the NHS Excellence Awards 2026.