A facility that provides only testing does not meet the AASM Standards for Accreditation as a sleep disorders center and, therefore, cannot be accredited by the American Academy of Sleep Medicine.
A sleep program may accept directly referred patients; however, no program may be more than 80% direct referral. A directly referred patient is one who is never seen in consultation by a sleep staff physician. The referring physician orders the sleep study, then treats and provides longitudinal care for this patient. A patient who is sent by the referring physician for a sleep study and is seen in consultation by a sleep staff physician within 3 months of the sleep study is not a direct referral. The medical information provided by the referring doctor must be reviewed by the medical director or a designated sleep center staff physician prior to performance of the sleep study on the directly referred patient. The site visitor will review cases of direct referrals if a program accepts them.
The Standards for Accreditation recommend a maximum of two patients for each technician under usual circumstances. Technicians generally work 40 hours per week. Most programs have technicians work either three 12-hour shifts (with some daytime work to reach 40 hours) or four 10-hour shifts. The patient volume statistics on the application for accreditation should indicate that these parameters are being followed.
Passing the registry examination provides evidence of the commitment and level of expertise needed to perform sleep testing. At least one member of the technical staff of the sleep facility must be certified by or accepted to sit for a certification examination by the American Board of Sleep Medicine or the Board of Registered Polysomnographic Technologists (BRPT). This individual must be on staff with this facility at least 30 hours per week. Additionally, all technicians not certified by the ABSM or BRPT must be enrolled in A-STEP or enrolled in a CoA PSG training program, or a CoA END or CoARC training program with the add on track for polysomnography.
Standards D-6 and D-7 provide requirements for testing bedrooms. All testing bedrooms must be single occupancy, private and comfortable. They must be of sufficient size to allow access for emergency personnel with a minimum of 24 inches of clear space on three sides of the bed. The testing bed must not be smaller than a standard hospital bed. At least one bedroom and bathroom must be handicap accessible.
This program should consist of regularly (at least quarterly) measured indicators that encourage continuous improvements in patient care. The program must also provide for a regular review of polysomnogram scoring to ensure inter-scorer reliability with the individual meeting Standard B-4.
The program must measure at least three other indicators of the facility's choosing in addition to inter-scorer reliability. Examples include but are not limited to the timeliness of reports, patient satisfaction, and sentinel events. Each facility determines the level of acceptability for the quality indicators they select. These thresholds should be evident in the quarterly report. Further, actions that will be taken should a facility fail to meet these thresholds should be clear.
Please review sections F and J of the Standards for Accreditation for more details.
Yes. All members of the technical staff, regardless of job duties, must be certified in CPR per Standard B-11.
Per Standard D-8, sleep facilities must have at least one bathroom for every three testing bedrooms. Bathrooms must contain a toilet and a sink and have a working privacy door. At least one bathroom must be handicap accessible.
Per Standard H-5, a cumulative database, specific to the applicant facility, should be created. This database must include the final diagnosis for each patient using ICSD-2/ICD-9 terminology. The database must include data for all patients of the sleep facility, even those who do not require a sleep study.
Yes. Facilities that are undergoing a significant change such as change in ownership, management status or location must contact the AASM in writing within one month of the change. In most instances, a center will be required under the special circumstances section of the application to submit an application. Facilities may opt to submit a special circumstances application or a complete reaccreditation application. The facility will receive a 90-day extension of accreditation while the application is being reviewed. This may be followed by a site visit. The report of the site visitor will be reviewed by the Executive Committee and, if approved, accreditation will continue through the original term in the case of a special circumstances application or will be extended five years in the case of full reaccreditation.
Please review the Application for Accreditation for the full Special Circumstances policy.
A referring doctor is usually a primary-care physician who refers patients to the sleep center. Physicians listed among a facility's professional staff are not considered referring physicians.
A consultant is a clinician who refers patients to the sleep center and also sees patients from the sleep center for specialized evaluation or treatment.
A direct referral is a patient who is never seen in consultation by a sleep staff physician. The referring physician (PCP for purposes of this question although it is recognized that physicians other than primary care providers may send patients as direct referrals) orders the sleep study, then treats and provides longitudinal care for this patient. A patient who is sent by the PCP for a sleep study and is seen in consultation by a sleep staff physician within 3 months of the sleep study is not a direct referral.
The most common mistake is failing to review the application for completeness and accuracy. Unnecessary delays of up to 8 weeks can be avoided by a detailed review of the application.
Examples of incomplete data in an application:
They want to see that the designated board-certified sleep specialist (the individual meeting Standard B-4) or a corporate appointed board-certified sleep specialist is the gold standard against which all technicians/technologists who score tests are compared. Applications that rate one scorer against the technical director or a chief technician are inadequate.
The gold standard and each scoring tech independently score the chosen epochs. Inter-scorer reliability is to be completed on 200 continuous epochs of three nocturnal polysomnograms per quarter for a total of twelve records per year. Inter-scorer reliability is to be compared for respiratory events, sleep stage scoring, leg movements, and arousals. Reliability of sleep stage scoring is on an epoch-by-epoch basis so that a percentage of agreement is reached.
Each sleep program determines its own acceptable percentage of agreement for each parameter, such as 85 percent or higher. A clear standard for a percent agreement with the gold standard meets the requirement.
The inter-scorer reliability policy also must include the steps that are taken when a scoring tech falls below the program-defined level of acceptability. Examples of remedial actions include regular reading sessions with a more experienced scorer, additional training at a school of sleep technology, or review of a computerized scoring training program.
Emergency procedures should clearly outline the responsibilities of each tech on duty. Further, emergency policies should include clear instructions for contacting either the medical director or the on-call physician when an emergency occurs. At a minimum, emergency procedures should include the following:
The length of a visit can vary depending on the site visitor assigned to your facility and the quality of the facility itself. Generally, site visits for new accreditations will begin at 8:00AM and end by about 2:00pm. Reaccreditation site visits will begin at 8:00AM and end around noon. Visitors will not observe overnight operations.
Case samples must include the original note from consultation with one of your sleep staff physicians, results of sleep studies (if any were done), and at least one office follow up note in which the patient was advised of the results of the study and a treatment plan was formulated.
It is recommended that the medical director complete the application for Accreditation of Out of Center Sleep Testing in Adult Patients.
The Standards for Out of Center Sleep Testing in Adult Patients specify that devices must meet the minimum definitions in CPT codes 95800, 95801 or 95806, or one of the HCPCS codes G0398, G0399 or G0400. Please review the capabilities of the device(s) you use to determine if the device meets the definitions.
The term sleep service entity is used in the Standards for Accreditation of Out of Center Sleep Testing in Adult Patients and the accompanying application. The term sleep service entity refers to entities performing out of center sleep testing (OCST).
A typical site visit will commence at 8:00 a.m. The length of the site visit varies and is determined by complexity of the visit.
You will need to complete a modified application for OCST Accreditation when your center undergoes reaccreditation. The AASM will provide more information about OCST Accreditation as part of the reaccreditation process at a later date.