Photo: Some of the team responsible for Sleep Service’s stunning success – (l to r) Karon Johnson (sleep assistant), Adele Jack (physiologist), Marilyn Davies (receptionist), Rhaddie Juanio (physiologist), Jo Hollobon (regional coordinator, Pathways of Care), Christine Scott (project manager, Pathways of Care), Karen Cottle (team leader, Sleep Clinic).
Barely a year ago, Waikato Hospital’s Sleep Service was struggling with a demand it couldn’t meet and high staff turnover. It has now transformed itself into an accessible service in which patients are seen and assessed in a timely fashion, and where staff morale is high.
Outgoing lead clinician for Sleep Service Dr Asad Khan says a drastic reorganisation of the service was needed, but how that happened – with a lot of staff input and collaboration from other services – was a key reason it has been such a success.
“We held a series of brainstorming meetings with all types of staff, from consultant to health care assistant. Any issue could be laid on the table, provided that a solution was suggested as well,” he says.
The service was driven by the knowledge that treating patients in a timely way is really important. People with untreated obstructive sleep apnoea (OSA) are at risk of road traffic accidents, causing harm to themselves and others. Sleep problems can also result in emotional, social, physical and psychological impacts on the individual, their partners and their families.
The solutions came in different shapes and sizes –
- much clearer pathways for GPs to follow when they referred a patient to the service, avoiding the need for a specialist appointment before a sleep study;
- interactive education sessions with GPs;
- a move to home-based sleep studies, with only complex cases needing to come to the more costly and labour-intensive overnight hospital-based sleep study;
- group education sessions for patients to familiarise them with equipment they could use at home, rather than one-on-one appointments. The group sessions have also helped patients form support networks with others suffering from the same condition.
All of these initiatives involved collaboration between the Respiratory and ENT (ear, nose and throat) departments at the hospital and the DHB’s GP Liaison team.
There was also a painstaking review of the Sleep Service patient database to identify those who were using their treatment well and responding clinically, and could be placed into an ‘on hold’ category.
“This means that while we don’t follow them up routinely, they can call us any time in the event of a problem and we will bring them in without the need for a fresh GP referral,” Dr Khan explains. Out of a total of 3591 patients, 2198 are now ‘on hold’.
And the creative solutions keep coming. The service is introducing Cloud technology soon to monitor high-risk patients such as heavy vehicle drivers.
“This will spare them the inconvenience of travelling to Waikato Hospital just to have their machine usage checked. We will also be able to adjust their machine settings remotely if needed,” he says.
The results speak for themselves. Referrals per month are up, but the number of patients waiting for a sleep study has almost halved due to faster processing. Those who need a hospital-based sleep study wait about one month compared to almost 6 months a couple of years ago. The numbers of patients waiting for a home-based sleep study has skyrocketed, but their waiting time has been held steady at about 3-4 months because of better processes. Specialist doctor appointments are now only needed for a tiny percentage of patients, instead of almost all.
Not surprisingly, feedback from patients and GPs has been positive.
Dr Khan pays tribute to the determination, flexibility and unstinting cooperation of staff.
“The challenges are by no means over – referrals have nearly doubled in the last four years due to the increasing burden of sleep disorders, and we are constantly reinventing ourselves to keep up. However we are confident that with our new systems and the staff’s ‘can-do’ attitude, we are better placed than ever to address the demand.”