When New Abstracts and Papers in Sleep (NAPS) sends out its weekly e-mail update, Kerry Kelley, RRT, RPSGT, and her fellow techs race each other to the computer to print out articles.

"It's about sharing our information," she said, and their passion for sleep medicine.

Dedication to patient care is just one of the many ways Kelley's facility separates itself from all the rest. As such, ADVANCE Newsmagazines proudly names the Sleep Disorder Center at Morristown Memorial Hospital in Morristown, N.J., the winner of our third annual Best Sleep Facility of the Year Competition.

Since opening its doors in 1990, the American Academy of Sleep Medicine-accredited, 10-bed center has conducted more than 26,000 sleep studies. This experience shows in some of the staff's innovative efforts.

The continuous positive airway pressure donation program, in particular, displays the center's altruistic spirit.

Years ago, they encountered numerous patients who didn't need their equipment because they either lost weight and no longer had sleep apnea symptoms or switched to a different machine.

Throwing out the CPAPs would be a waste, explained Marc L. Benton, MD, medical co-director of the center. So, they decided to have patients bring in their used equipment, and after the biomedical department checks the devices out, the staff distributes the CPAPs to indigent patients.

"It allows us to do things for people that otherwise wouldn't get done," Dr. Benton said. "It was just a question of connecting the dots and making it happen. It was common sense."

Center Coordinator Neil S. Friedman, RN, RPSGT, would like to see more labs around the country employ similar programs. "It's really a simple thing to do," he said.

Reaching out to the community is nothing new for the North Jersey facility. In the past year, staff members have participated in local health fairs, hospital screening programs and nursing in-services; lectured at colleges, bariatric programs, corporations, religious organizations and libraries; and been interviewed by newspapers, magazines, and radio and TV news shows.

They also have enjoyed some great success with their CPAP support groups. In fact, they had to change the location to a larger venue because the first meeting drew close to 150 sleep apnea sufferers. "People were elbow to elbow," Kelley remembered.

CPAP compliance ranks high among the list of priorities for the sleep center.

On the night of the study, patients watch an informational video that offers a comprehensive overview of sleep-disordered breathing and CPAP use in general. If an individual is scheduled for a titration or split-night study, the staff allocates additional time and performs a CPAP familiarization trial.

"We have found that allowing the patients the chance to review several mask options and experience wearing a mask prior to data collection lets them 'wade in' to CPAP use," Kelley said. "Giving the patients the opportunity to ask questions and experience CPAP in a relaxed, friendly environment significantly helps eliminate any concerns they may have."

Within two weeks of the patients' titration, they receive a laminated "CPAP Alert Card" indicating the appropriate level of pressure. In case the person needs surgery, the card enables the hospital staff to apply the correct therapeutic setting for postoperative CPAP use, Friedman said.

A letter that accompanies the card includes helpful CPAP hints and a direct number at the center that the patient can call for assistance with CPAP-related problems or concerns. The facility also offers them unlimited gratis follow-up visits with the technical staff. Many patients find these extra meetings critical to their treatment.

"The real strength we have is our technical staff," said Robert A. Capone, MD, medical co-director. "They are really the backbone of this place. They're very, very good at what they do, and it shows in the way people respond to them."

Training and Continuing Education
One initiative that has proven successful in increasing quality of care, Friedman said, is their polysomnographic technologist training program.

When the facility's higher-ups needed new technologists because of the sleep center's continued growth, they choose to staff it with employees recruited from the hospital's respiratory care and neurodiagnostic departments and create their own in-depth education program to develop sleep professionals.

The center's physicians, management and technical staff worked together to set the training philosophy, curriculum and course structure. The multiphase six-week program - full of required readings, hands-on training, and biweekly written exams to assess their progress - encompasses the principles of PSG and provides a comprehensive knowledge of sleep physiology.

They also created a 260-page training manual to give those new to the field a visual resource and an academic model to help aid their study of sleep and PSG procedures. Plus, new employees work closely with seasoned professionals who guide them from their introduction to sleep to their board certification.

Since implementing the program, four employees received their RPSGT, and Friedman brims with confidence that the three most recent hires will pass the June exam, making the entire 12-person technical staff credentialed.

"One of our goals in developing the training program was to impress upon new staff members the importance of viewing their work in sleep as a profession, not a job," he said. "They have to be passionate about it."

The love of sleep medicine carries to the value they put on continuing education, a responsibility shared by all the technologists.

Each month, one staff member develops a multiple-choice test for his or her co-workers based on a current article of note. The topics range from light therapy and seasonal affective disorder to advances in pharmaceuticals to REM behavior disorder in Parkinson's disease and dementia with Lewy bodies.

"This allows the technologists to share personal sleep interests while expanding their own knowledge of the physiology/pathology of various sleep disorders," Kelley said.

This wealth of information comes in handy because the staff (many of whom have at least 15 years experience in sleep) have to care for numerous problems, including insomnia, parasomnias, narcolepsy, periodic limb movements, restless legs syndrome, and, of course, sleep apnea.

"There are 80 different sleep disorders," Kelley said. "Believe me, we're not just looking at one. You're our blank slate at the beginning of the night."

Once the diagnosis gets filled in, though, the praise flows almost instantaneously.

"When a patient comes out of his room after a CPAP titration and tells me he feels great, I can't tell you how rewarding that is," Friedman said.

The gratification Kelley receives from her career path can't be beat, she added. "I've had patients say to me, 'I define my life by before treatment and after treatment.'"

***

Honorable Mention - OSF Saint Francis Sleep Disorders Center, OSF Saint Francis Medical Center, Peoria, Ill.
The words, "That's not my job," rarely pass the lips of an employee here. They have clinical, technical and clerical staff working side by side, and staff members are cross-trained as much as possible to accomplish the work at hand - even if the task is outside of one's usual duties.

"This creates a true work team," said Sarah Zallek, MD, the sleep disorders center's medical director. "Everyone in the department has an active voice. We leave no process etched in stone and make changes to our system all the time based on each employee's input. If any one of us sees a better way of doing something, whether it involves patient flow, communication, quality or any other aspect, that idea is considered and usually implemented."

Some innovative programs include: new scales to measure subjective fatigue and sleepiness; and a detailed online patient database, which in addition to the separate database of PSG information, provides searchable data for the purpose of retrospective clinical research while maintaining patient confidentiality.

Research plays a big role at this sleep center. They presented four original abstracts at the 2004 Associated Professional Sleep Societies meeting and have a whopping seven on tap for this June's conference.

***

Honorable Mention - Sleep Disorders Program, Tampa General Hospital, Tampa, Fla.
Improving the quality of work done here is of the utmost importance. To meet this goal, they established their Score at Home program. It allows techs to score studies in the comfort of their own home instead of coming into the office. It increased productivity by 12 percent and has allowed for a timelier turnaround of PSGs.

"This has had a major effect on our employees who can spend more time at home with their families and that has led to better patient outcomes by improving employee morale," said Daniel Ventimiglia, RRT, RPSGT, manager of outpatient respiratory care services.

The facility also encourages a high degree of education to ensure that the patient gets the best care possible. Techs receive the financial backing of fully paid education for advancement in sleep training, including review courses and exams.

Mike Bederka is associate editor of ADVANCE. He can be reached at mbederka@merion.com.

Competition Details
Nominations for this prestigious award came from the sleep community itself, and experts in the field judged the entries. Facilities selected for recognition were judged on their ability to develop innovative programs, take novel approaches to improve productivity and patient outcomes, effectively cope with the challenges of today's health care world, implement gold standards of care and new technology, pursue continuing education and certification, improve recruitment and retention of staff, and go above and beyond to reach out to the community.

The awards will be presented in June to coincide with the APSS and APT annual meetings. The first-place facility will receive a $1,000 cash prize and a plaque; honorable mention winners will receive special certificates.

The judges for ADVANCE's 2005 Best Sleep Facility of the Year Competition were: James McKenzie, MS, RPSGT, technical director of the Sleep Disorder Center, DeKalb Medical Center, Decatur, Ga.; Brenda Ross, RPSGT, sleep laboratory manager at Carle Hospital, Urbana, Ill.; Ralph Pascualy, MD, medical director, and Bonnie Robertson, RPSGT, CRT, clinical/lab director of Swedish Sleep Medicine Institute, Seattle; and John Basile, BS, RRT, manager of Swedish Sleep Therapy Supply. All were winners in last year's competition.