Sleep Labs

Look at regional patterns for sleep lab success

Many sleep lab owners and managers looking to establish or grow their practices endeavor to do so using straightforward marketing efforts directed at patients and referrers. But according to one expert in the field, this “build it and they will come” approach often results in misplaced efforts to grow the business.

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Look at regional patterns for sleep lab success

Many sleep lab owners and managers looking to establish or grow their practices endeavor to do so using straightforward marketing efforts directed at patients and referrers. But according to one expert in the field, this “build it and they will come” approach often results in misplaced efforts to grow the business.

In addition to owning a number of sleep diagnosis centers, Joe Petrolla is the president of Seeley Medical, a full-service medical equipment company in northeast Ohio and western Pennsylvania. He’s worked in the healthcare sector since 1988 as a business owner as well as in sales and marketing, most notably as director of sales development for Respironics.

Mr. Petrolla contends that when it comes to developing and growing a sleep lab practice, ignoring local patterns of diagnosis, referral, and treatment will most likely result in wasted marketing efforts. These patterns vary from region to region, so there is no one-size-fits-all approach.

When setting up sleep lab centers in his county, Petrolla examined the practices of general practitioners in the region. “One of the things we found out,” he states, “was that there was a low level of awareness about the prevalence of sleep apnea. When we asked how many sleep apnea patients they saw in a year, physicians reported ‘only a handful.’”

Petrolla discovered that when faced with a patient complaining of extreme fatigue, the physician’s first course of intervention was often a blood test and subsequent referral to a specialist. “The possibility of a sleep disorder wasn’t the first thing they considered,” states Petrolla. “They rarely asked how the patient was sleeping and whether or not he snored, for example.” Additionally, the physician’s own clinical practice was being adversely impacted by this “referral first” approach.

Armed with this information, Petrolla was able to take a tailored approach toward increasing referrals to his sleep center. He managed to convince physicians that sleep diagnosis could become a larger part of their regular practice if they engaged the services of an independent sleep lab rather than referring patients to a specialist. Physicians were encouraged to take part in sleep diagnosis training, and this prompted the realization that they had potentially missed diagnosing a sleep disorder in a number of their patients.

This detailed groundwork resulted in the ability of general practice physicians to grow their own practices by diagnosing sleep disorders in patients without referring them to a specialist. Surprisingly, because the physicians were recognizing more sleep disorder cases, referrals to specialists didn’t drop off as one might expect. A higher number of patients diagnosed meant a higher number of patients who required specialized care, so everyone involved benefitted. Utilization of independent labs for diagnosis of sleep disorders also improved the speed of care and maintained the relationship that had been established between the primary care physician and patient.

Without taking the time to look at the diagnostic, referral and treatment patterns at play in his region, Petrolla says he would have “missed the boat” in terms of how to best market his sleep diagnosis services. He’s careful to point out, however, that directly promoting awareness of sleep disorders to patients and physicians also has its place.

He explains that one of the most effective ways his company drove demand was to have “Do you snore?” awareness posters in physician exam rooms. This often prompted a conversation between patient and doctor that otherwise might not have occurred.

How important do you think diagnosis, referral and treatment patterns are for building your practice? We’d love to hear your comments.

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Sleep Labs

MANAGING CLINIC DEMAND AND QUALITY OF CARE

Wayne Thompson is the sleep lab coordinator at the Sleep Disorders Centre, Misericordia Health Centre in Winnipeg, Canada. Given his 20 years of experience in Polysomnography, 15 years of that as a coordinator, Biowaves was interested to learn how the sleep lab environment has changed over that time.

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MANAGING CLINIC DEMAND AND QUALITY OF CARE

Wayne Thompson is the sleep lab coordinator at the Sleep Disorders Centre, Misericordia Health Centre in Winnipeg, Canada. Given his 20 years of experience in Polysomnography, 15 years of that as a coordinator, Biowaves was interested to learn how the sleep lab environment has changed over that time.

BioWaves: What are your responsibilities at your sleep lab?

Wayne Thompson: I oversee 22 PSG staff members, order and evaluate equipment, train staff, execute sleep studies, coordinate and participate in research, manage the sleep studies database and act as liaison among the lab, the public and Manitoba Health Region.

BioWaves: Sounds pretty busy. How many patients do you see in your sleep lab monthly?

Wayne Thompson: We do 280 in-lab studies and 200 home-based studies. The physicians see between 300-400 patients a month either pre- or post-sleep study.

BioWaves: Have things changed in terms of the role or practice of sleep technologists over the past two decades you’ve been working in this area?

Wayne Thompson: Yes, there’s been a lot of change that has required a higher skill level for PSG techs. We’re definitely seeing more complex cases as the result of demographic shifts. Age and obesity factors, for example, have meant heavier, sicker patients coming through our doors.

We are also seeing many more patients with neuromuscular disease such as post-polio, ALS and MS who require nocturnal ventilation. The majority of end-stage neuromuscular patients resist invasive therapies (i.e. ventilator and/or tracheostomy), so we help ongoing assessment of their nocturnal breathing changes and manage them with non-invasive breathing support therapies.

BioWaves: What are key challenges facing your sleep lab right now?

Wayne Thompson: Time is a huge factor as demand for our services continues to grow. Along with that time crunch comes the challenge of maintaining high quality sleep studies and patient care.

BioWaves: How is your sleep lab addressing these challenges?

Wayne Thompson: We are in the process of setting up controls to monitor staff performance in order to evaluate overall efficiency and productivity. This will help us to more effectively evaluate quality assurance measures.

This evaluation will help management make decisions about workload issues such as hiring more staff or adopting technology that can improve productivity.

BioWaves: What do you do to foster best practice within your team?

Wayne Thompson: We strive to instill a culture where taking pride in one’s work is valued. PSG techs have a unique ability to improve quality of life for their patients through their knowledge of polysomnography, respiratory physiology and patient care. We stress the importance of our techs maintaining expertise in these areas.

Staff members are required to earn 10 educational credits per year as part of their performance evaluation. There are opportunities to get credits in-house and externally. With our current quota of scoring 4-5 sleep records per day at 1-3 hours required per chart, there aren’t many hours available for learning. But even simple opportunities can be beneficial such as reviewing case or technical issues in a group setting.

I make an attempt to teach and share my knowledge with our technologists and encourage them to share their knowledge with others as well. I truly believe that fostering a learning environment is important for our lab in an effort to keep turnover low. When there isn’t the time or opportunity for personal and professional development, people start to feel their time here is more of a job than a career choice. Each person needs to be a stakeholder and feel that they are making a valuable contribution toward running the Centre.

• Do you experience challenges in your sleep clinic? Can you share ways you’ve addressed challenges successfully? We’d love for you to share your comments with us.

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Monitoring / Polysomnography

Innovator puts sleep scoring problems to bed


It wasn’t long after Dr. Magdy Younes established the sleep laboratory at the Health Sciences Centre in Winnipeg, Canada, that he was struck by how long it took a qualified technologist to score a sleep study. Even more troubling than the average scoring time of two hours was what he discovered about the reliability of the process.

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Innovator puts sleep scoring problems to bed


It wasn’t long after Dr. Magdy Younes established the sleep laboratory at the Health Sciences Centre in Winnipeg, Canada, that he was struck by how long it took a qualified technologist to score a sleep study. Even more troubling than the average scoring time of two hours was what he discovered about the reliability of the process.

As the only sleep physician on staff, it was left to Dr. Younes to review all the sleep records the lab generated. When he routinely discovered scoring errors, he was determined to understand why they were happening. He knew that it couldn’t be the training or skill of the technologists as he had handpicked a highly qualified staff.

“I determined that the task of scoring sleep studies is an extremely boring and tedious one that, even in the best hands, can result in distraction and errors,” states Younes, a Distinguished Professor Emeritus at the University of Manitoba and a Senior Scholar in its Department of Medicine. His further examination revealed that some of the scoring guidelines require precise measurements that can’t be performed in practice because of time and cost pressures.

Familiar with using computers to develop models to address fundamental research questions, the doctor immediately thought of using technology to resolve the sleep scoring problems. Younes notes, “Computers do not suffer boredom and can execute precise measurements very quickly.”

Throughout his medical and research career, Younes has been driven to address unsolved medical problems, but it wasn’t until he retired in 2001 that he could dedicate his full attention to medical innovation. He established a research and development company that initially focused on a series of inventions related to mechanical ventilation. In 2007, Younes made development of automatic sleep study scoring a priority.

Younes knew that for the technology to be effective and accepted by the sleep medicine community, it needed to address the realities of real-world sleep lab conditions. He immediately turned to Michele Ostrowski, his chief sleep technologist during his tenure at Health Sciences Centre, for advice and assistance on the project. During the time they worked together, the two had often discussed issues related to sleep study scoring.

“When I saw what I perceived to be scoring errors,” Younes recalls, “Michele would sometimes agree with me but at other times would not. We’d have heated debates and almost invariably she won after citing relevant references and doing precise measurements.” For Younes, there was no question that Ostrowski’s enthusiasm and obsession with quality would make her the perfect “gold standard” for the software’s algorithms and an invaluable consultant for the user interface.

The launch of the Michele Sleep Scoring software in May 2012 was the culmination of several years of research, development and rigorous testing. Younes is certain the end product has been worth the time and effort.

Clinic efficiency and productivity were clearly important goals in developing Michele Sleep Scoring, but Younes is quick to point out an immediately tangible benefit to the patient as well. He explains that the time required to perform manual scoring often means the patient has to visit the clinic a second time to get a result and diagnosis.

“Using Michele Sleep Scoring,” says Younes, “a file can be scored in the morning directly after the patient undergoes the study. This allows the physician to review the results with the patient before she/he goes home to face another night of poor quality sleep.

 

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