By RamMohan Gumpeni, MD, Victor Beauvil, RRT, PhD, Orsete Dias, PhD, Arunabh Talwar, MD, FCCP
The coronavirus is a health crisis of immense proportion. It is increasingly clear that the current healthcare delivery models will be defined by a clear demarcation: the period before COVID-19 and the new normal that will emerge in the post-viral era: the “next normal.”
This pandemic has ushered in a dramatic restructuring of the healthcare delivery model different from what the health practitioners and patients traditionally operated within. So how does the current epidemic of COVID-19 affect the practice of sleep medicine and its subsequent effects on respiratory therapists?
Sleep Medicine practices have had to balance efforts to reduce viral exposure and transmission, the need to triage healthcare resources and personnel, and maintain access to care. Let us see how this affects the practice of sleep medicine in the post-COVID-19 healthcare settings as well as how respiratory therapists can be prepared to make their jobs more relevant and valuable in the changing scenarios of the practice of sleep medicine.
There is no denying that respiratory therapists have special knowledge about upper airway management. They serve a critical function during procedures related to trauma, anesthesia, life support, and emergency medicine. They are a key part of any sleep medicine team, and they can expect to play a role in the growth of sleep medicine.
McKinsey and Co., in a very interesting and thought-provoking paper, have put forward five stages, leading from the beginning of the COVID-19 pandemic to the next normal that will emerge after the battle against coronavirus has been won: Resolve, Resilience, Return, Reimagination, and Reform.
Resolve – How can the Sleep Center/Lab meet the demand of the current crisis with minimum humanitarian impact?
– During the crisis, most inpatient testing has been cancelled. The focus has been on Home Sleep Testing.
– Respiratory therapists can help with home study testing, downloading the data from the returned machines sent by the patient, also help with sanitization and disinfection of the returned devices.
– Convenient drop-ship of disposable home testing solutions with web-cloud connectivity is already available. Every RT working in a sleep lab must learn the details of the technologies in use by their sleep physicians. They can render accurate diagnoses from objective measures of sleep architecture and sleep-disordered breathing. Disposable units can also minimize delays to diagnosis and spare lab personnel the time and expense required to decontaminate HSAT devices.
– During the crisis and in the coming few months, in-house CPAP/BIPAP titration will be limited. Therapists can help with online CPAP titration. They need to stay ahead with the concepts of online learning and education delivery tools [ Zoom, etc.] RTs should learn how to present webinars on these topics.
-Respiratory Therapists are experts in PAP therapy. They can be an integral part of the team that helps patients with adherence to PAP devices, which is the key to successful management and treatment.
Respiratory Therapists should educate patients to know their PAP provider company and machine settings. Usually, a home medical equipment company (HME) provides patients their masks, tubing and filters. Patients should put the HME company contact information and their PAP pressure settings directly on their machine for easy access. During this current viral epidemic, HMEs are limiting their exposure by providing telehealth in-home checkups, instruction by video, and drive-by equipment pick-ups. Patients should be reminded that knowing their PAP settings are useful if they find themselves in a situation where their medical records are not available.
Resilience – How does a sleep center survive the loss of revenue from the current pandemic?
– The focus has turned to telemedicine. Practitioners and respiratory therapists should avail themselves of telemedicine portals, which can facilitate health checkups while eliminating the risk of disease transmission.
– Respiratory Therapists can help with online support for patients with support groups as well as CPAP adherence.
– In the current home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. It may increase not only daytime stress, anxiety, and depression levels but also disrupt sleep and emotional functioning of individuals. Respiratory therapists must acquaint themselves with Cognitive Behavioral Therapy elements that are feasible to implement for those with insomnia.
– Understanding and learning the new non-contact sleep devices: The world’s first non-contact sleep tracking system, manufactured by ResMed, the S+ helps users analyze and improve sleep by recording light, noise, and temperature readings. It syncs with a smartphone and provides tailored feedback and suggestions on how to improve one’s sleep and sleeping environment.
Return – How does a sleep lab ‘restart’ post COVID-19 in an effective way while minimizing risk to patients and staff?
– Sleep centers should have a policy of testing patients with a nasal swab before they arrive for an in-lab sleep study.
– Respiratory therapists can take a lead role in coordinating these tests and also volunteer to do these swabs to expedite the process.
Reimagination – How will sleep centers fundamentally reinvent the business of sleep medicine in the changed situation post-COVID-19?
– The AASM has correctly recognized the threat posed by the COVID-19 pandemic to sleep center operations and patient care. The sleep medicine community can limit contagion without compromising patient care by (1) embracing telemedicine as mentioned above and, and by (2) utilizing disposable home sleep test diagnostics.
Disposable HSATs can help to streamline patient care. Devices like WatchPAT ONE [Itamar Medical] is a disposable home sleep testing solution that offers the same simplicity, accuracy, and reliability of an in-lab test. Every respiratory therapist who works in the sleep lab should familiarize themselves with WatchPAT ONE and other HSAT products on the market. The simple smartphone app transmits the WatchPAT ONE data from the seven-channel recording to the cloud. As soon as the study is completed, clinicians can review the automated study results.
Reform – How will the relationship between insurance, licensing agencies, and practitioners and support staff [NP, PA, RT] change? What actions can be taken to both preempt a future health crisis and support the reimagined system of the future?
– Practitioners should have a voice in changing reimbursement vis a vie the insurance companies.
– There will be more emphasis on research, education, and online health care delivery. Future respiratory therapists need to learn not only the craft of respiratory therapy but should be technically savvy enough to cope with the coming changes in healthcare delivery technology.
COVID-19 has disrupted the lives of all of us. And this new coronavirus is creating a dilemma for those suffering from sleep apnea and other sleep problems. Is it safe to go to a sleep center for a sleep test? Should I visit a doctor for a consult and risk an infection? Respiratory therapists can play a pivotal role in helping patients with sleep-related breathing disorders in the current changed healthcare milieu by keeping themselves abreast of emerging sleep diagnostic and management technology. These steps can greatly extend the overall reach of the practice and scope of sleep medicine.
RamMohan Gumpeni, MD1, Victor Beauvil, RRT, PhD2, Orsete Dias, PhD2, Arunabh Talwar, MD, FCCP3
1. New York–Presbyterian Queens Hospital, Flushing, NY
2. Mandl School, The College of Allied Health, New York, NY
3. Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, New Hyde Park, NY
4. Ellemarije Altena . J Sleep Res. 2020;00:e13052
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