Improving Processes in the Sleep Lab

1. Improving Processes in theSleep Lab Division of Pulmonary and Critical Care Medicine Department of Neurology Clinical Neurodiagnostic Laboratory Center for Sleep Disorders

2. Improving Processes in theSleep Lab Team Membership: • Division of Pulmonary and Critical Care Medicine • Department of Neurology • Clinical Neurodiagnostic Laboratory • Center for Sleep Disorders

3. Opportunity Statement and Desired Outcome Our sleep lab began to experience an increase in wait times for routine sleep studies and patients requiring a sleep study should receive one within two weeks (internal standard) from the sleep physician’s approval. In order to provide the best service to those patients requiring a sleep study, it was necessary for us to identify ways to expedite the appointment process. Goal:While maintaining patient and physician satisfaction, we wanted to reduce the 3rd available appointment wait time and also increase the number of sleep studies performed

4. Identification of the Current Process • ADMINISTRATIVE & SCHEDULING PROCESS: • Sleep study requested and physician approval received • Patient contacted and appointment scheduled into IDX • Appointment letter is mailed to the patient • Paperwork arranged for the sleep physician and PSG technologists • STUDY PERFORMANCE: • Patient arrival and performance of the study • Completed study reviewed and preliminary scoring performed • PSG REPORT PROCESS: • Physician finalizes the study and performs dictation • Report is transcribed and reviewed/signed by the physician

5. Identification of the Current Process • All available appointments were presently being utilized • Growing need for appointments indicated a need for more patient slots/beds to meet demand • Increase in patient volume would necessitated infrastructure changes (new equipment), protocol and new process’. • Increase in patient volume necessitated additional staff and (technical and administrative) • Increase in volume necessitated further physician availability

6. Solutions Implemented • Increase the number of sleep beds available for testing • Begin a plan to update the present PSG equipment • Recruit and train additional PSG technical staff • Restructure technical staffing – create a four-step career ladder to stabilize and retain staff • With IT, begin to network the lab and allow “off-site” performance, archiving/securing of data • Develop an intradepartmental program for educating residents and fellows across service lines • Obtain sleep lab accreditation (AASM)

7. Results Patient Satisfaction increased and remains EXTREMELY FAVORABLE For survey question “Would you recommend our Sleep lab to someone?” 2004 2002 2003 2005

8. Results Third available patient wait times decreased from 60 (FY2002) to 25 (FY2003) to ONE day! Third available patient wait times decreased from 60 (FY2002) to 25 (FY2003) toONE day.

9. Results Study volume increase from an average of 56/month to 124/month

10. Conclusions and Next Steps While we are currently meeting the needs for appointment availability, the Sleep Program has a number of goals for the coming year: • Further improve the effectiveness of present bed use and staffing • Marketing of Sleep Program services • Provide sleep disease/disorder education internally and externally • Continue to develop LUHS interdepartmental relationships Beyond 2005: • Expand sleep lab services to a 12-bed facility • Expand CME-related experiences • Develop outreach sessions for patients and families • Expansion of sleep clinics and better integration with the sleep lab