8 Hour Sleep Clinic will turn four years old later this year, and despite their relative youth in sleep medicine, there are a lot of amazing things happening with their sleep practice. In our sleep story of the month, we dive into what makes EnsoData customer, 8 Hour tick, highlighted by insights from their technical director, Dayana Arellano, and their medical director, Dr. Joseph W. Dombrowsky, MD. According to the team, the key to 8 Hour’s success is in their commitment to providing the best possible patient care, often leveraging the best technologies and training programs. Optimizing the patient experience is the driving force behind the majority of their business decisions, especially in the wake of the global COVID pandemic.

Prioritizing Patient Care Leads to HST and In-Clinic Growth

Better Patient Care is the Promise

When asked what helps 8 Hour rise above the other sleep clinics, Arellano stressed patient care more than anything. “We are 100% about patient care, patient satisfaction, timeliness, and comfort,” said Arellano. “Everything we do is about our patients, 100% of the time.” You might ask, how does 8 Hour bring action to their words? Arellano mentions that having the best training and technology in place can make a world of difference.

“Having been in sleep medicine for 20 years, I can say that this is the first time I’ve been at an organization where it is truly focused on leveraging cutting edge technology to provide better patient care,” Arellano said. “We also focus on highly trained staff. From day one, we have had a very defined training program for sleep technicians.” 

8 Hour is committed to employing a well-educated and well-equipped staff in their centers. The combination of better resources, both in the sense of professional development opportunities and on-the-job tools, help make this a reality.

How Dayana Got Started at 8 Hour

While 8 Hour turns four this year, they may not be here had they not hired Arellano. When she joined the team, it was just a small group, with only four others on the books: the CEO, Medical Director, COO, and Chief of Billing. Several of these team members had never worked in the world of sleep before, so the team needed someone with experience in sleep. When Arellano came on board, she was bringing the longest history in sleep to the table, with over 16 years at various sleep centers.

And the best part? The team listened to her.

“I walked in, and we got to work,” said Arellano. “The team was relatively new to sleep medicine, but they wanted to know what other sleep centers were doing to replicate those successes. We did our research, asked around and talked with dozens of people. Our team even went and experienced sleep studies at other places. Our driving mission was to answer this question: how can we bring a better experience to the patient? Dating back to day one, it has always been 100% about the patient.” 

Sounds like the whole 8 Hour team has the same mission: provide better care for all patients.

A Sleep Center Focused on Training

Proper sleep technician training was one of the first things for Dayana to focus on as technical director. She came in as a lead scorer, but the 8 Hour leadership team realized her potential early on, allowing her to spearhead the training program. Arellano developed the curriculum for the center, primarily based on the AASM modules. From the onset, 8 Hour primarily focused on ensuring all their sleep technicians are registered and experienced.

“Once we established a strong team, we set out to bring in carefully screened and selected sleep tech trainees. Our training program is based on AASM modules as well as educational and clinical experience recommended by American Board of Sleep Medicine testing for Registered Sleep Technologists candidates,” said Arellano of the training program. “I put together study materials for on the job trained technicians, and then we broke it down into six months of training. During that process, there are certain competencies that must be mastered and signed off on for each technician. This helps us make sure we’re bringing in the right people to serve our patients.” 

When you consider that 8 Hour has 2 locations, 16 beds, over 35 employees (some part-time/PRN) including 16 sleep technicians, and has been simultaneously experiencing rapid growth in the last 4 years, training appears to play a huge role in their success.

Transitioning Care In the Wake of COVID

For businesses of all varieties, the pandemic has been a challenging time. This is no different in sleep, though the difficulties of telecommunication and telemedicine have their own unique challenges.

Dr. Dombrowsky Quote Number 2

1. Telemedicine Adoption in Elderly, Pediatrics Is Challenging

One of the biggest hurdles has been in technology use and adoption in older communities. For their older-aged patients, things taken for granted by millennials (like Zoom meetings and other technology aspects), have created new barriers to care and support.

“Some patients are not familiar with Telemedicine and the various types of Telemedicine platforms we tried, such as zoom or FaceTime. So, it’s hard to find a solution that works for everyone,” says Arellano. “We were always focused on remaining 100% HIPPA compliant, asking what can we do to better connect with patients?”

8 Hour also has a high-volume of pediatrics patients, as the team boasts the only physician in El Paso with extensive experience with pediatrics. This poses additional communications challenges, but Arellano says their team has found solutions.

2. In-Lab Work is Still Required, especially for Treatments

For patients already on therapy, in-lab manual downloads of data were necessary. Prior to the pandemic, 8 Hour’s patients were able to bring in their equipment for cleaning and management, but in the wake of COVID, they can’t do that anymore. Arellano mentions it’s also difficult to direct proper mask fittings when not in person. Trying to get compliance data downloaded in time is another related challenge. To combat these various issues, Arellano and the 8 Hour team added staff to their DME department. 

With more manpower calling to get compliances, the team started making bigger strides forward. Progress allowed for the team to create a number of telemedicine DME service appointments: allowing patients to show what they’re doing with masks and other problems, and providing staff the opportunity to walk patients through best practices and solutions.

3. Setting up Curbside Pick-up Practices was a Priority

As initial telemedicine offerings were being fine-tuned, curbside pick-up was the next big step. Per Arellano, it has been challenging to optimize the pick-up process, especially with the telemedicine restrictions, but with curbside pick-up, some patient obstacles appear less daunting.

4. When in Doubt, Trust the Classics

Ultimately, there were a couple of “older” solutions that served well. Arellano cited simple phone calls as an effective way to communicate with elderly patients. She also mentioned that texting and other simple communication methods have been used in special circumstances.

Sleep Center Operational Changes

Quote from Dr. J. Dombrowsky of 8 Hour Sleep Clinics

In the wake of COVID, many operational elements have changed. Implementing telemedicine was a huge step for the 8 Hour team, but like most sleep centers, increasing in-lab volume is pivotal to the long-term success of the organization.

“We’re working on negative pressure rooms to see if it’s possible to safely do titrations. We’re being very cautious and thorough in putting patient’s safety first,” said Arellano. “Every single patient is screened and marked for a high or low risk for COVID. Every chart is marked, so everyone who touches that chart, from billing to technical as well as day time operators, knows the patient risk factor.” 

This highly specific process is allowing the 8 Hour team to slowly ramp up PSG testing, with June eclipsing May’s total testing numbers. They are also implementing a process that includes testing for COVID the day before their in-lab tests. Patients are screened and then if COVID tests come back negative, (that’s a good thing, Michael Scott), the 8-hour team welcomes them in for titration studies in the clinic.

“Every day, every week, every month, we’re learning how to live with this pandemic and how to deal with it,” said Arellano of the changes being made. “I don’t think sleep medicine, and medicine in general, will be exactly the same ever again. But we have great leadership from our CEO, as well as our Medical director, and our 8 Hour Family/Team is dedicated and committed to finding ways to provide our patients with the best care that we can, and that’s where we can start.” 

Getting Back to Pre-COVID Volumes Takes Time

In January, 8 Hour was employing 16 sleep technicians, and between the two centers, they were running upwards of 470 sleep studies per month, Monday-Saturday. Arellano mentioned that prior to COVID, testing was primarily done in-clinic, with a smattering of HSTs to go along with it. “Because of how busy we were at the time, we started looking into AI scoring programs to augment our team’s scoring and improve turnaround times,” she said. 

The 8 Hour team has always performed “on the fly” night scoring with a day scoring element, primarily for thoroughness and accuracy. Arellano mentions that there can be a 20 percent scoring disparity from technician to technician, so she’s advocated from day one to have a combined approach featuring both on-the-fly night scoring and daytime scoring. Dr. Dombrowksy then sifts through results to provide his final recommendations, meaning each patient has three touch points from the 8 Hour team.

It was 8 Hour’s commitment to accuracy and thoroughness that prompted them to look into AI scoring options to help get a lasso around the volume issues they were experiencing (pre-COVID). While experimenting, they demoed a couple scoring options, but Arellano was initially wary of the capabilities of AI scoring algorithms, as this was her first foray into the world of AI-assisted scoring.

For Arellano, having zero previous experience with an AI solution was a blessing in disguise. Unlike many technologists and directors at sleep centers, she hadn’t been let down countless times in the past by “autoscoring solutions” that simply weren’t market-ready. Most solutions before EnsoSleep simply didn’t reach the bar and have created a general aura of AI-failure in the sleep community. That wasn’t the case for Arellano, though that didn’t keep her from being wary of AI as a solution.

Better Patient Care is Possible with AI Sleep Scoring from EnsoSleep

“I didn’t have any experience with autoscoring. To be honest, I didn’t think it was going to be as safe or as accurate as our technicians,” said Arellano. When they first began exploring options, the initial instinct was to work with their diagnostics equipment provider, who had an internal option in play. During their research, Dr. Dombrowsky learned about EnsoSleep, and there was an introductory meeting with a demo of the product. After that initial meeting, the 8 Hour team was leaning in favor of the internal diagnostics option, as that transition appeared easier.

Adding EnsoSleep has Changed Everything, per Dayana Arellano of 8 Hour Sleep Clinic

A few months later, Arellano was speaking with an owner of an EHR company, who also happened to own a sleep center using EnsoSleep. The two were discussing 8 Hour’s current issues – increased backlog, higher volume demands, scoring delays – and one could say there was a bit of a technological awakening on Arellano’s end. (Sorry for the sleep pun!)

“That conversation really opened my eyes and changed my train of thought. We had another meeting with Enso, and it was the best thing that we could have done,” says Arellano. “Adding EnsoSleep’s AI has changed everything in terms of how fast and how accurate we are testing more than anything. After all, speed means nothing if it’s not accurate. With Enso, we can offer better service and faster service for patients. Results are ready from one day to the next, it’s no longer two or three days, which is amazing.”

That’s one of the biggest reasons for optimism at the 8 Hour facilities. The combination of her well-trained technologists and the ability to scale volume with the help of EnsoSleep’s assisted scoring has positioned their team to rebound from COVID (eventually) and provide better care without breaking the bottom line.

“We all need to generate business,” said Arellano, “but as I’ve said, I think the majority of your efforts should stay with patient satisfaction and care. That’s what technology has helped us do during this pandemic.”

A Legacy of Caregiving, Educating

When asked about her future, Arellano says she might never leave El Paso. She loves her community, she loves her work, and she loves where she lives. She started in medicine at 15 as a nurse’s aide and fell in love with the caregiving aspect of the medical field. After 20 years in sleep, she laughs that she meant to become a teacher, but that’s not how life worked out. Instead, she’s found a way to be an inspiring educator within the 8 Hour team and the sleep community. She teaches every day, training new technicians and imparting her wisdom.

Dayana Arellano Quote on Patient Care

Ultimately, Dayana wants to be remembered as a caregiver. She’s always been focused on the people around her. When she was first in the technical director role, she thought about all the past experiences she had with her former directors. They were mentors to her and she vowed to live up to their legacies. She vowed to be remembered for caring for others and always striving to do better. Someone told her years ago: “you care too much about other people,” but it is simply her innate drive to support and nurture others, and we commend that mission.

“Your legacy and how people remember you at the end of the day is what you have left,” she said. “I want to be remembered for caring for people: my team, my patients, my family.” 

We couldn’t have found a better way to say it. Cheers to Dayana and the full 8 Hour team: way to put the care back in healthcare.

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