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Background Healthcare disparities across ethnic groups are well-documented, yet little is known about ethnic diversity in tertiary care ventilation referrals and acceptance decisions. As gatekeepers to specialised interventions, tertiary units play a crucial role in healthcare equity. We characterised the ethnicity of patients referred to and accepted by a tertiary specialist weaning and complex ventilation unit to identify potential healthcare inequities.Methods This was a retrospective analysis of consecutive referrals (October 2020 – February 2024) made via a secure online interface to a tertiary complex ventilation and specialist weaning unit. Referrals were categorised as level 2 (non-invasive ventilation review/domiciliary setup), level 3 (tracheostomy ventilation review/domiciliary setup) or remote non-invasive ventilation setup. Patient ethnicity was categorised by Office for National Statistics Standards, recorded by referring clinicians using 19 categories (classification 20b) and then grouped into 5 grouped classifications (classification 6a). Chi-square tests were used to assess statistical significance of categorical variables.Results Of 748 referrals received (Age: 63 (±20), 52% male), 489 (65%) were accepted. Referrals originated from 59 hospitals across 24 of England’s 42 Integrated Care Boards (ICBs) (57.1%), with the majority (95%) from the South East region, including 43.9% from London.Ethnic distribution of referred patients was: White (576, 77%), Black (73, 9.8%), Asian (40, 5.3%), Mixed (8, 1.1%) and Other (51, 6.8%). Diagnostic patterns varied significantly by ethnicity (p<0.05). A higher proportion of White patients had COPD (22.7%) compared to Asian (7.5%), Black (8.2%), Mixed (0%), and Other (13.7%) groups. Conversely, a higher proportion of Asian patients had a diagnosis of neuromuscular conditions (57.5%) than in White (35.9%), Black (28.8%), Mixed (25%), and Other (39.2%) groups.Despite these diagnostic differences, acceptance rates were equitable across all ethnic groups, with patients accepted in the same proportions as they were referred (p=0.66).Abstract P227 Table 1Patient demographics, referral patterns and acceptance rates by ethnicity compared to census data. Data presented as median (IQR), n (%) and % for census dataConclusion This single-centre study demonstrates equity of acceptance to a tertiary ventilation service across ethnic groups despite diagnostic case-mix differences between ethnic groups. Continued monitoring and clinical pathway review are essential to ensure sustained equitable acceptance and a clear understanding of the ethnic diversity of referrals for patients requiring ventilatory support.