Tuesday, November 13, 2007

Reader Comments on Home Testing, "certified polysomnographer"

This is an interesting take on the issue. For me, "certified polysomnographer" does not by default include RRTs. THE ONLY ONE BY DEFAULT IT DOES INCLUDE IS RPSGTs.As a Sleep tech since the early eighties, the costs associated with PSG have grown from the staffing side of the equation. At first, I worked in a world class Neurology based sleep laboratory. I was paid a salary commensurate with other Neuro-based technicians. Only with my move to a pulmonary based sleep facility, did I enjoy a major "bump" in my salary, as the facility did not have a pay scale for this "sleep tech" classification. Taking this new job allowed me to be the only technical sleep person in the facility and as such, I fit a unique role, but got wedged into a generic technician job category. I quickly exceeded that description and moved up, and hired other techs to work under me. Some of them had Respiratory backgrounds, and thus, we equalized the sleep tech and respiratory therapists pay scale, since we had to pay some "techs" who were also RTs. This now raised our costs significantly. We are paid equal to the RTs in Respiratory, but that was just a market demand, the equation of duties is nowhere near equal. The RTs, working in "Respiratory" perform Respiratory treatments, and we perform Sleep testing and Sleep treatments, irrespective of one's background. The only RTs who can perform sleep medicine testing and therapies are the ones the AASM, ACCP, and ATS have considered appropriate; those that are properly educated and proficient in sleep medicine. Otherwise, they are performing outside of their scope of practice. So, in the end, my history does not offer a similar perspective on the issue of cost, as the equipment has lowered in cost, but the staffing has artificially increased. And, as these two major components of sleep testing continue to hurtle towards their eventual end points, the need to control quality sleep medicine in whatever aspect, arena or capacity a patient is tested in, should ALWAYS fall to properly trained and experienced individuals. As for a 3/1 pt/tech ratio, 3 techs (whatever their backgrounds) taking care of 9 patients with all of the hand holding and interaction that patients undergoing PSG for titrations, pediatrics, or seizures, etc, necessitate, it does at least include a modicum of expectation of response from the technical staff. The 3 patients being taken care of, offer no consolation for the 6 (66%) of the other patients possibly calling out for them.Proper ambulatory testing can be accomplished, if all portable testing go through sleep doctors; on the front end (proper sleep consultation) and the back end; (sleep doc interpretation.) This would force the "certified polysomnographers" to be the ones performing these portable testing duties, and how that will interplay with the expectations of different allied health field entrants into the pool of "certified polysomnographers," we will have to wait and see. Some of these entrants might get bored, thinking that portable sleep testing and therapies is below their training, and some might find it a very interesting and important aspect to the milieu of sleep testing, that if anything, this shows is not stagnate.
Thank you for your comments on this post. I agree that "certified polysomnographer" should = RPSGT. However, respiratory therapists are making power plays in some states. For example, in some states respiratory therapists are trying to enact statutes making it mandatory that a respiratory therapist be present during all CPAP/BiPAP titrations.
As for technician/patient ratio, I think that a 3:1 ration would be appropriate only under limited circumstances (adult patients, psg's - not titrations). I agree that the current standard of 2:1 leads to better quality studies. However, I feel that portable home testing is vastly inferior to both ratios.

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