At Pitt County Memorial Hospital Sleep Center, 25 years of experience and 2,666 sleep tests per year are just the beginning.
Pictured are (from left): Daniel O. Lee, MD; Teresa Kelly, manager; and Ginger Edwards, administrator.
When a facility has been around for as long and done as many sleep studies as the Pitt County Memorial Hospital (PCMH) Sleep Center, its staff eventually sees almost everything. There are about 88 different kinds of sleep disorders, says Daniel On-Fai Lee, MD, medical director for the PCMH Sleep Center. And we are focused on dealing with all of them.
Located in Greenville, NC, the AASM-accredited PCMH Sleep Center is part of the six-hospital University Health Systems (UHS) of Eastern Carolina. The UHS serves a 29-county area in eastern North Carolina, and PCMH is its flagship 740-bed magnet hospital. This means that the PCMH Sleep Center is conveniently located for the more than 1.2 million residents of the surrounding area.
We treat such a variety of people, from pilots to truck drivers to farmers to children, says Patty Holman, supervisor, PCMH/UHS Sleep Center. We also experience a vast assortment of sleep disorders on a daily basis, which allows us to treat not only the primary illness but secondary illnesses as well.
And with the addition of targeted services, patients are starting to come from well outside the 29 surrounding counties. For example, as the recipient of a multimillion-dollar National Institutes of Health grant, PCMH/UHS has seen an increase in gastric bypass patients. These individuals also receive care at the Sleep Center. Prior to the surgical intervention, it is becoming the gold standard for those patients to undergo a sleep study evaluation, Lee says, adding that clients have traveled to the PCMH Sleep Center from as far away as Virginia and South Carolina.
Serving all needs
Working with gastric bypass patients is just one collaborative effort taking place between the Sleep Center and PCMH/UHS. The team also coordinates with a whole host of specialties to provide a total care package. We have many medical specialists who work with us, providing comprehensive care for our patients, Lee says. Everyone is not alike. Some people may require additional treatment, such as from psychiatrists; psychologists; ear, nose, and throat physicians; or surgeons.
Another example of this approach to complete care includes equipping all of the centers CPAP machines with monitoring devices that indicate if the mask was worn as prescribed. These monitoring devices are the reason the Sleep Center boasts a CPAP-compliance rate of 92%, according to Lee. It also helps staff members ensure patients are receiving effective care. If they are not using the machine, it may explain why theyre still having high blood pressure, for example; if not, there could be another problem, he says. Putting the compliance meter on our CPAP machines helps us better evaluate and better care for our patients.
While the center has been around for more than 25 years, before 2001 all of its operationsincluding four sleep study roomswere squeezed into 1,000 square feet of space. In early 2002, the center moved into a new building with eight times the amount of space and three times the number of beds.
Moving out of the hospital, but staying nearby, has greatly improved patient convenience, says Ginger Edwards, administrator, Special Medical Services, PCMH/ UHS Sleep Center.
Jenny Hopkins helps Dinese Jackson relax before her sleep test.
Once patients get to the PCMH Sleep Center, they find that its designers tried to make the amenities inviting for them whether they are on-site for a few hours to visit with a specialist, or spending the night as part of a sleep study. Each of the 12 private roomseight adult bedrooms and four bedrooms in the pediatric podhas a private, handicap-accessible bathroom. Adult rooms come equipped with televisions and recliners, as well as independent climate control.
Form did not beat out functionality in the design of the PCMH Sleep Centers new space. Currently, all scheduling and registration of patients are done electronically with medical records maintained on-site in hard copy. Information systems at the PCMH Sleep Center are slated to go digital as UHS converts to a new electronic medical records system over the next 3 years.
The investment seems to be paying off as the staff continues to see tangible results from the new space. In the last fiscal year, the PCMH Sleep Center completed 2,666 sleep tests, thanks in part to diligent scheduling strategies that work to fill every bed, every night. This approach has decreased wait times, while simultaneously increasing the number of studies that can be performed.
On the cutting edge
In addition to performing sleep studies and providing treatment, the PCMH Sleep Center involves itself with multiple ongoing trials and research studies. Lee, a member of the National Sleep Foundation, is often at the helm of these projects. Our goal is to continue to expand not only in terms of taking care of clinical patients, but through research, so patients can have access to a full scope of services, he says.
In the past year, the Sleep Center has published five papers on various sleep disorders, including one in Pediatric Nephrology about the correlation between OSA and hypertension in children. Results of another recent study into restless leg syndrome were published in Movement Disorders.
[Restless leg syndrome] is such a common disorder, about 150 times more common than Parkinsons disease, Lee says. Yet there was no FDA-approved medication for it, which is why we took on that task.
Through the cumulative efforts of Lees team and physicians at Johns Hopkins and the New Jersey Neuroscience Institute at the John F. Kennedy Medical Center, last month the FDA approved the first medication for the treatment of restless leg syndrome.
An open door policy
A cornerstone of the PCMH Sleep Centers philosophy is consistently providing follow-up care to patients. In addition to the diagnostic and therapeutic testing available at the center, a sleep clinic is open every weekday. For the last 8 years, these clinics have helped make services more attainable to the public.
The clinic allows us to keep the patients on our continuum of care and ensure that they come back for follow-up visits and communication about their disease, explains Edwards. We can work with patients to measure their progress and help make sure they realize the outcomes we want them to have.
In the clinics, patients are seen by appointment, but can come either because of a physician referral or by self-referral, if they are having problems they want to discuss with a sleep professional.
Initially, patients who come in receive an assessment by one of the sleep specialists to determine whether a sleep study is required or if they need some other type of treatment, says Teresa Kelly, manager, PCMH/UHS Sleep Center. As treatment moves forward, patients are monitored to guarantee they are informed and educated about their disorders.
Daniel O. Lee, MD, explains the test results to Dinese Jackson.
Many of the specialists, such as adult and pediatric pulmonologists and neurologists, use the clinic to hold regular office hours. Conducting clinic visits at the center gives the staff a chance to help patients get acquainted with the environment before arriving for their first all-nighter.
It allows us an opportunity to give the patient exposure to the sleep room through a tour of the area, and education about the tests, which helps reduce the first-night effect considerably, Edwards says. An added benefit is that they know where to go for results, additional testing, or appointments with other specialists.
The clinics also provide a mechanism to do follow-up on patients, according to Kelly, who adds that the PCMH Sleep Center aims to track a patients progress for at least 1 year after initial treatment. This is no small task considering the number of patients that pass through the Sleep Center. In the 2004 fiscal year, the clinics staff saw approximately 4,364 patients.
The right people, the right result
Even with all the physical pieces in place, the bottom line for a sleep centers success lies primarily in the quality of its team. Teresa and Patty make sure the level of knowledge and skill is where it needs to be and consequently the quality of reports and tests is outstanding, Edwards says. First and foremost, we want to serve our patients well.
Because delivering outstanding care is such a high priority, patient service-oriented activities are not limited to the sleep research institute basics. PCMH Sleep Center staff are actively involved in ongoing patient education and support, for example by sponsoring quarterly AWAKE (Alert, Well and Keeping Energetic) patient support group meetings.
We will also have vendors come in and demonstrate different types of CPAP equipment, making themselves available for patients to ask questions, Kelly says. The PCMH Sleep Centers staff extend meeting invitations not only to their own patients, but to anyone in the surrounding communities. We really see it as an education opportunity for everyone, she says.
In addition to actively participating every year during National Sleep Awareness Week, the staff regularly conducts education and awareness activities throughout the region. We go out to area schools and work with children and their parents, Kelly says. We have really concentrated on educating the community about the sleep disorders that impact the kids.
This commitment to service shows in the Sleep Centers routinely high scores on patient satisfaction surveys. A private company contracted through UHS calls approximately 30 Sleep Center patients every quarter, asking questions developed specifically by the Sleep Centers clinicians, managers, and staff. The most recent year saw an average score of 4.57 (using a 5 point scale).
At the national level, the team rates just as well. Random canvassing performed by the same private company that performs the quarterly patient surveys returned satisfaction rates in the 90th percentile range, according to Lee.
Success comes not only from keeping patients happy, but by maintaining close partnerships with referring physicians. As part of that process, Kelly travels to physicians offices several times a year to meet with their staffs and address any issues or concerns they may have with the procedures performed at the Sleep Center.
I ask what kind of job they feel we are doing and just try to stay on top of their needs, she says. I want them to know we are dedicated to giving them what they expect from us.
Above all else, the staff members of the PCMH Sleep Center focus their collective efforts on providing quality, safe, and efficient services to their clients. For Lee, it is this type of teamwork that sets the PCMH Sleep Center apart from its competition.
We have registered specialists and board-certified sleep physicians all working together to treat our patients, he says. But the number one factor that sets us apart is our peoplethey make all the difference.
Dana Hinesly is a contributing writer for Sleep Review.