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Staff Experiences with a Team-based Approach to Sleep Medicine Referrals: A Qualitative Evaluation.

Donovan LM, Mog AC, Blanchard KN, Magid KH, Syed AS, Kelley LR, Spece LJ, Palen BN, Arfons LM, Kirsh S, Au DH, Sayre GG. Staff Experiences with a Team-based Approach to Sleep Medicine Referrals: A Qualitative Evaluation. Annals of the American Thoracic Society. 2021 Nov 17.

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RATIONALE: Sleep disorders are highly prevalent, and the volume of referrals sent to sleep specialists frequently exceeds their capacity. In order to manage this demand, we will need to consider sustainable strategies to expand the reach of our sleep medicine workforce. The Referral Coordination Initiative (RCI) takes a team-based approach to streamlining care for new specialty care referrals by 1) incorporating registered nurses into initial decision-making, 2) integrating administrative staff for coordination, and 3) sharing resources across facilities. While prior work shows that RCI can improve access to sleep care, we have a limited understanding around staff experiences and perspectives with this approach. OBJECTIVE: Assess staff experiences with a team-based approach to sleep medicine referrals. METHODS: From June 2019 to September 2020, we conducted semi-structured interviews with staff members who interacted with RCI in sleep medicine. We recruited a variety of staff including RCI team members (nurses, medical support assistants), sleep specialists, and referring providers. Two analysts used content analysis to identify themes. RESULTS: We conducted 48 interviews among 35 unique staff members and identified six themes. 1) Efficiency: Staff described impacts of the RCI program with regard to efficient use of staff time and resources. 2) Patient access and experience: Staff noted improvements to patient''s ability to receive care. 3) Staff wellbeing and satisfaction: Specialists and RCI staff described how RCI mitigated the adverse impact of triage volume on staff wellbeing. 4) Sharing specialty knowledge: Nurses and specialists discussed the challenges of sharing specialty knowledge and training nurses to triage. 5) Nurse autonomy: Staff discussed nurses'' ability to make triage decisions in the RCI system and highlighted the crucial role that decision support tools play in supporting that autonomy. 6) Coordination and communication: Staff noted the importance, challenges, and facilitators of coordination and communication across facilities and at the interface of primary and specialty care. CONCLUSION: Staff endorsed positive and negative experiences around the RCI system, identifying opportunities to further streamline the referral process in support of access, patient experience, and staff wellbeing.

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