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One local DME supplier made the following comments when I asked about this.
"My perception of the controversy is this …. AARC is fighting to ensure that PSG techs MUST BE LICENSED RESP THERAPISTS and not just PSG techs – anyone off the street … There are so many sleep labs popping up these days and in many states anyone can be trained in house to do the diagnostic set up on sleep study night…putting on the leads, monitoring the patient and overseeing the collection of data.
AARC is not wanting to “read the studies and diagnose”. That’s a physicians role.
The AAST (American Association of Polysomnographic Technologists) is having a fit and trying to protect their organization state by state too.
I am not sure who has the upper hand – but it is a big fight. I think its going to boil down to licensing. What if a patient, undergoing an overnight sleep study “codes” or has severe respiratory issues – that’s one of the big points….Joe Blow sleep tech hired off the street with only a few weeks of training may not be the best person to deal with patient health – that’s one of the cases they are making."
Ideally, in my opinion, it is a team effort. A lot of the responsibility falls on the patient to educate himself to effectively coordinate his team, though.
I have read of DME employees that have bent over backward to address patient needs. I have heard tell of RTs helping docs understand how to write better prescriptions. And I have heard of docs helping patients figure out comfort adjustments to machines. So sometimes the key is someone willing to cross a line.
The way the responsibilities are divided are for a reason. But I think everyone--patients, docs, techs, and RTs--are in agreement that in many ways the system is broken, despite the fact that some professionals find ways to do great work. The rate of compliant users in appalling. Good people in the industry are getting frustrated. I say kudos to the people who find ways to do good every day as they help patients. But there is room for improving the system. And getting good RTs involved with helping patients directly can't hurt.
I don't think an RT has to know that much about sleep medicine to be of help to a sleep doc figuring out how to write a sleep-machine prescription for a COPD patient. As long as they work well together, they could come to terms with what is in the patient's best interests coming at the problem from different angles.
Maybe.
But what do I know.
Mike said:my ultimate question is who is best equipped to deal with tweaks/modifications to the mask interface and machine and to troubleshoot patients' problems, which inevitably arise. we know it's not the sleep doctor; we know it's not the DME (except for Daniel Levy -- who is in a league of his own), so the question is who is it?
The mess was precipitated by the creeping of bilevel PAP w/ respiratory rate into mechanical ventilation land, as well as the advent of ASV for sleep disordered breathing treatment. When those devices are applied clinically, they cross over into the traditional & legal definition of respiratory care practice. You are right, Judy, many RTs know diddly about PAP. It will take some years to sort this out. Meanwhile, consumer resources like SLEEPGUIDE are essential to get good info to PAP users caught in the crossfire between the sleep & RT communities.
I'm almost afraid to reply to this thread. I'm an RRT working in sleep, I just happen to also have my RPSGT. In the lab that I work in we are all dual credentialed. We are all RRT and are either RPSGT or will sit the board within the year of hire.
Our previous manager is now teaching at one of the community colleges and teaches an sleep medicine class to the RT students.
I don't know how it is in other labs but here we're glad that the tech next to us is also an RT. I would rather have somebody that has had some medical background doing my study than somebody picked up off the street and trained to do the set up and how to minimally troubleshoot a study. I think this discussion here has gone off on a tangent on how qualified the RT's are that do the home care, i.e. provide equipment in the home. I don't have anything to do with PAP setups I just do the titration on our inlab machines and do my best to get a good fitting mask to suggest to the homecare. My "job" is to help diagnose and to treat sleep apnea. I don't know about other labs but 90% of our patients have sleep apnea or nothing at all, rarely do we see another sleep disorder. And if we do see something else it's usually Narcolepsy or periodic leg movements in sleep or, even more rarely, a parasomnia. At any rate I think the AARC wants to continue to have RT's able to be eligible to sit the exam without lengthy schooling and just the concentrated training to learn the EEG side of things.
I can't address the DME issues I do not have to handle or deal with that end of it. The DME RT's that I have met have been very knowledgable about PAP and are informative with their patients. Unfortunatley you find bad eggs where ever you go.
Cindy
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