P137: Characterizing GenomeConnect participant experiences receiving VUS results identified via cancer panel testing

but notably higher in non-ICU settings.Among major clinical indication categories, the highest yields were observed for genitourinary abnormalities (48%), neurologic concerns (41%), and orofacial malformations (42%).Strikingly, "faltering growth" (formerly "failure to thrive") showed the highest diagnostic yield overall-66% across all units and 68% in non-ICU pediatric wards (27/40).Diagnoses in this group included a range of monogenic and cytogenetic disorders, such as KMT2D-related Kabuki syndrome, CTNS-related cystinosis, and Williams syndrome.Only three diagnoses recurred across multiple individuals, underscoring genetic heterogeneity.Conclusion: This large single-center experience demonstrates that hospital-wide access to first-tier rES/rGS yields diagnostic rates equivalent to or exceeding those reported in prior ICU-restricted studies.The particularly high yield among children admitted for faltering growth suggests that rapid genomic sequencing can uncover diverse, actionable etiologies in a population often subject to prolonged and invasive diagnostic workups.Findings highlight the clinical utility of extending first-tier rGS beyond ICU settings, with potential to accelerate diagnosis, inform management, and improve equity in access to genomic testing.The results may underestimate true diagnostic potential, as patients with metabolic or mitochondrial disease evaluated through the separate biochemical genetics service were excluded.Hospital-wide implementation of first-tier rES/rGS enabled equitable access to genomic diagnosis across all inpatient units.Diagnostic rates were consistent with or better than prior ICU-based studies, with the highest yield observed among children with faltering growth.These findings support routine, first-tier use of rES/rGS for all hospitalized children with suspected genetic disease, not limited to intensive care settings.