Meeting the Moment During the Pandemic

UH ENT Chair Nicole Maronian, MD, recent winner of a “Dinner with the Doc” award, has achieved stellar results as interim Chair of Sleep Medicine

UH Clinical Update | September 2021

During the heart of the pandemic in 2020, as many people postponed medical appointments, UH ENT’s home sleep program increased sleep studies by 8 percent.

Nicole Maronian, MD

Even more dramatically, the time that patients had to wait for a first appointment decreased from 81 days to four; the days they had to wait for the first available sleep lab appointment declined from 60 days to 10, and the physician read-time of lab results went from 90 days in 2019 to five days in 2020.

These changes occurred under the leadership of Nicole Maronian, MD, Chair, Ear, Nose & Throat Institute and Interim Chief, Sleep Medicine. As a result, she was one of the physicians selected this summer to receive a “Bravo” award as part of the Cliff Appreciates program – a new initiative designed to celebrate the outstanding contributions of our physician caregivers. These physicians were selected through a nomination process because they have Advanced Systemness or demonstrated a Commitment to Value.

Dr. Maronian gives credit for these improvements to the entire sleep team, including physicians and advanced practice providers, and Kelly Robertson, Director, UH System Sleep Labs, all of whom pitched in to figure out methods of efficiency that would dramatically cut patient wait times.

“Seeing the unique pathways in which each physician contributed their expertise for the benefit of patients, their teams and UH was truly inspiring,” said Dr. Maronian. “It gave me new ideas to carry forward.”

Nicole Maronian had precisely two careers she was interested as a teen: medicine and diplomacy, with an emphasis on languages. She grew up in Rochester, N.Y., having moved there with her parents from Germany when she was 6. Her father was a general surgeon and her mother, who’d been a teacher in Germany, was a homemaker.

Working in her father’s office when she was in high school – mostly filing, and sometimes accompanying him on rounds - made her see that medicine would be the right choice. “I love the association of hands-on help to take care of people,” she said. “I’d always gravitated toward science, and then being exposed to medicine through my father helped me make my decision.”

While at the University of Rochester Medical School, she started in general surgery. But she soon was drawn to ENT because of its focus on communication and the impact that the field has on all of a patient’s senses.

 “I ultimately completed an ENT fellowship in voice, airway and swallowing disorders, which has been the primary focus of my career.  When I first started practicing, I also performed sleep apnea surgery, as it often involved airway expansion.

“Being involved in sleep at this current level – as interim chief of sleep medicine - brought the start of my career full circle with needs here at UH.”

Dr. Maronian joined UH in 2006, as an otolaryngologist at UH Cleveland Medical Center, UH Seidman Cancer Center and UH Rainbow Babies & Children’s Hospital. She became Director of the UH Ear, Nose & Throat Institute in 2016 and Chair of the Department of Otolaryngology – Head and Neck Surgery, in 2018.

In late 2019, the focus of work in sleep medicine was to increase its offerings, and improve access for patients by increasing staff and – with input from its clinicians – making processes more efficient.

 “We hired additional providers, and also broadened the multidisciplinary focus, because sleep also involves psychiatry, ENT and neurology,” Dr. Maronian said. “This evolved to increased engagement and referrals that met a huge need.”

The evolution of sleep medicine over these last years has benefited from our system focus on renewed well-being.  Sleep issues can also affect a patient’s diabetes control, or hypertension – and the current focus is on sleep health to promote overall better health for our patient population.

Interestingly, the pandemic turned out to be an optimal time for this renewed focus. Instead of patients waiting for an appointment for a sleep study at one of UH’s 9 locations, the sleep center provided an at-home sleep test mailed to the patient – where it might be easier for them to sleep than in a hospital bed.

Also, because of COVID-19, more people were not only postponing health care appointments but also spending more time at home – and likely had more stress in their lives. “All of this could accentuate sleep disorders in particular,” Dr. Maronian said. So in a way, the timing for home sleep testing turned out to be perfect.

Virtual visits with physicians increased dramatically at UH, so more sleep patients could also be “seen” by doctors, she said. “Offering the sleep tests at home, and the virtual visits, further increased patient’s trust in the sleep center. We also appreciated our very engaged providers in primary care, bariatrics and neurology who referred patients.

UH is fortunate to have significant expertise in all clinical areas impacting sleep, including pulmonary for patients with underlying lung disease, neurology for narcolepsy, ENT sleep surgery for patients interested in surgical correction, and psychology to treat insomnia with cognitive behavioral therapy.  “We are looking at all this comprehensively now,” says Dr. Maronian, whose role as interim chief of sleep medicine will transition in September, as Susheel Patil, MD, becomes the Medical Director for UH System Sleep Medicine Services.

Dr. Patil is a graduate of the UH/CWRU Internal medicine program, where he served as Chief Resident, with subsequent fellowships at Johns Hopkins in Pulmonary and Critical Care and Sleep Medicine. He is leaving the role of Clinical Director of the Johns Hopkins Sleep Program to join UH as of September 1.

He will lead the systems’ sleep labs, along with all clinical sleep operations, as he grows UH’s academic presence nationally in terms of sleep research and publication.