Leading the Way on Patient Safety During COVID-19

Jonathan Sherrill, left and Dr. Said Mostafavi lead quality efforts at Advanced Sleep Medicine Services. Both are CSS board members.

How can sleep centers help improve patient safety during the current crisis? Jonathan Sherrill has answers. Jonathan, who is the General Manager and Technical Director for Advanced Sleep Medicine Services, presented on patient safety during the COVID-19 pandemic at the California Sleep Society’s COVID-19 Town Hall Webinar May 29, 2020.

We’re fortunate to have Jonathan and our Chief Medical Officer, Said Mostafavi, MD, leading our quality and patient safety effort. Jonathan has worked in the field of sleep medicine for more than 20 years and holds the Registered Polysomnographic Technologist (RPSGT) and Registered Sleep Technologist (RST) credentials, and teaches Clinical Polysomnography as an adjunct professor at Orange Coast College. Dr. Mostafavi is double board certified in sleep medicine and board certified in pulmonary diseases and on the clinical faculty at UCLA. Both Jonathan and Dr. Mostafavi serve on the board of directors of the California Sleep Society. Jonathan and Dr. Mostafavi have worked together from the beginning of the pandemic to help Advanced Sleep Medicine Services meet the challenge of the new environment, through a variety of efforts including a top-to-bottom review of our policies, new procedures including patient screening and enhanced sanitization processes and additional staff training and communication.

Improving patient safety in the current environment requires overlapping redundant measures. At Advanced Sleep Medicine Services, we use a variety of measures to help make the testing environment and process as safe as possible for patients and technicians.

First are extensive cleaning and sanitization practices, including professional housekeeping and linen service with all rooms cleaned between patients and newly laundered bed linens for each patient (of course!) plus sanitization of all equipment and high touch surfaces. For door handles, light switches and other surfaces we sanitize with a heavy duty cleaning agent then place a plastic barrier film on the surface to indicate completion of the sanitization process and to provide a further safeguard. Each patient has his or her own private room and does not share a room with any other patient. For equipment, we follow the manufacturer recommendations including use of the specified sanitizing agent.

Second is patient screening. We have six points in our patient scheduling and communication process where we ask the patient about symptoms or potential exposure to COVID-19. The final check is at the time of the appointment and includes a temperature check with a no-touch forehead thermometer. If we identify risk factors we contact the patient and reschedule once we are able to determine the risk factors have been resolved. We’ve also surveyed our technicians and other employees regarding any potential risks or exposure.

Third is staff excellence, training and support. We hire the best technicians in the sleep medicine field and are extremely proud of our team. All of our technicians have the appropriate credentials with a large percentage having achieved the difficult RPSGT status. We have regular scheduled training for all our technicians and a strong quality improvement program including feedback to individual technicians. We’ve conducted separate training sessions focused on the current environment and how to make the overnight sleep study and home sleep testing processes as safe as possible. We support our technicians, including with our lead tech program. With the lead tech program, a rotating group of senior technicians works as the lead tech each night shift. The lead tech does not have their own patients for that shift and their only role is to provide support, education and feedback to the technicians who are caring for patients that night.

Fourth is required use of Personal Protective Equipment (PPE). Our policies mandate that technicians wear a mask throughout their shift and gloves for each patient encounter and other PPE such as face shields or aprons as appropriate. We also require patients to wear a face covering when entering or leaving our facilities (but not during the actual sleep study).

Fifth are updated policies specifically related to the pandemic. We greet each patient in the lobby and immediately take the patient to their room, so patients do not spend time together in the waiting room. We are conducting PSG tests only at this time to help reduce the risk of airborne virus transmission.

Sleep medicine is important. Having a sleep study can be a big step towards better quality of life and better health, and sleep apnea, one of the most common types of sleep disorder, is correlated with significant health conditions including heart disease, hypertension, stroke and diabetes. Patients need sleep medicine services, even in a period of increased risk. It’s great that, as we face these challenges, we have leaders like Jonathan Sherrill and Dr. Said Mostafavi to show the way.