Replies to This Discussion

Permalink Reply by Judy on June 28, 2009 at 11:20am

As far as I am concerned if the RRTs want to do PSGs then let them get off their duff and get the training needed to become RPSGTs as well. They don't want to invest in the RPSGT training then let them "bug out" and those RRTs working for local DME suppliers concentrate on improving their care, support, advice and mask fittings AND JUST AS IMPORTANT learning the equipment (xPAPs) they are providing!!!! Too many of them don't even bother to do that much.

Judy said:

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."

• ▶ Reply

Permalink Reply by Jim Nadolny, BS, CRT on June 29, 2009 at 11:11am

I am new to this site, and find this topic to be of great interest. For about 20 years I have been involved in the identification, diagnosis, and treatment of Sleep apnea. I have seen that some RT's are great at sleep, while others have been thrown into it without the proper training. 13 of my years were spent in Homecare where I would setup Cpap machines in patient's homes. I was always good at this because I had proper training in school and was mentored when starting out in homecare. The sad part is that as I grew with my company, I watched as young inexperienced Therapist would try do the job with out the proper training. This is a recipe for disaster! It is plain and simple RT's have the most appropriate background for all aspects of sleep therapy, however they should have specialized training if they want to specialize in this sector of Respiratory Care. Thats my opinion and I am sticking to it... By the way, The pathophysiology of sleep apnea is most certainly a Lung Function Issue. It is the most basic of all lung functions...Breathing or not Breathing(apnea).

j n k said:

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?

• ▶ Reply

Permalink Reply by Judy on June 29, 2009 at 4:45pm

The way I see it, instead of seeing to it that their RRT members maintain good standards of practice at local DME suppliers' facilities for apnea patients the AARC wants to horn in on the PSG field W/O their members having to invest in learning how to properly conduct at PSG. Too many of their members can't do an adequate job setting up an xPAP and fitting a mask yet they want to cash in on conducting PSGs W/O investing the money and time to learn how to properly conduct a PSG. If they want to conduct a PSG let them invest the time and money in proper training to do so.

• ▶ Reply

Permalink Reply by RockRpsgt on June 30, 2009 at 1:17am

Sleep is not a lung function. Apnea is not a lung problem.There are over 100 sleep disorders. less than 5% of those have to do with breathing at all. Why should respiratory have any control over sleep. I believe sleep should be a seperate entity away from respiratory. if it did need to be controlled by an existing group neurology would be the one to control it not respiratory. An REEGT has way more right to run a psg over an untrained RRT. The truth of the matter is the AARC is not recruiting the way it used too, and sleep is the cash cow of the medical industry. Why wouldn't the AARC want it.

I am not saying that an RT can't do the job. I have worked with some great ones. I have worked with some bad sleep techs. What really ticks me off are the RT's that come to sleep because it is easier than respiratory.

Welcome to the siter Jim.

• ▶ Reply

Permalink Reply by Rock Conner RRT on June 30, 2009 at 9:30am

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.

• ▶ Reply

Permalink Reply by RockRpsgt on June 30, 2009 at 9:50am

Rock, I truly do not believe that there is any crossfire going on. At least at the lab level. Ok it is not going on in my lab. i personally only see or hear about it on sites like this one or binary. As jnk posted sometime ago this is more of a political fight between the AARC and the AASM. Which is kind of funny because it is being settled on a state by state effort without either one of them. At least that is what I am seeing and being told by the powers that be.

i will give the AARC some credit for trying to branch out and add special licenses to their field. Sleep should do the same thing for scoring and peds.

Rock Conner RRT said:

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.

• ▶ Reply

Permalink Reply by Judy on June 30, 2009 at 12:31pm

What makes sense to me is that RRTs who want into sleep medicine choose their area and either truly learn the functionings of the various brands and models of xPAP and proper mask fitting, etc. OR take the training and get the accredidation as an RPSGT. The same goes for RPSGTs, if they want to get in on respiratory therapy then let them get the education and training to obtain their RRT accredidation which is admittedly a LOT more strenuous since if involves so many aspects of breathing and lung related problems.

Thank you, Rock Connor. If only we had scads and scads more RRTs like you!!!! We'd have a heck of a whole lot higher xPAP compliance rate, that is for sure!!!

• ▶ Reply

Permalink Reply by Judy on June 30, 2009 at 11:11pm

Yes, Cindy, thanks. You are one of the "good guys" and it sounds like you work in a GREAT sleep lab! I just don't happen to agree w/you about RRTs and the PSG training.

• ▶ Reply

Permalink Reply by RockRpsgt on July 1, 2009 at 3:11am

So what Cindy, because i did not go through a respiratory program I can't be a good sleep tech? because i am not an RT I don't know how to troubleshoot a study? I think that is a little harsh. i am not arguing whether Rt's can tech. My argument is that sleep should be on it's own. Yes they need to add strength to their training. yes they need to work out some bugs, but they should be on their own. If it looked like I was attacking any RT's I give my humblest apologies as that was not my meaning.

Cindy Brown said:

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

• ▶ Reply

Permalink Reply by Judy on July 1, 2009 at 7:59am

I feel that the RRTs should have to go thru the full RPSGT training and accredidation in order to conduct a PSG.

• ▶ Reply

Permalink Reply by Judy on July 1, 2009 at 3:28pm

Doggone it, Cindy, QUIT APOLOGIZING! You are giving us a side of the issue many of us haven't had access to. I appreciate your postings very much. Honest! I respect the various aspects of respiratory therapy and RRTs - except I disagree on the amount of training an RRT or ANYONE should receive to achieve the RPSGT accredidation. I just met a great RRT at one of our Universities during a COPD research trial. She knew the PROPER way to conduct a six minute walk test which the previous MA sure didn't as a for instance. We had a good conversation. When we got on the subject of sleep she said herself that she felt more and better training was needed by RRTs before being allowed to conduct PSGs. The RRT who does the ABGs and PFTs at our local hospital also said the same thing and is currently exploring the DME supplier RRT angle as well as having an interest in PSGs. He was appalled at how many local DME suppliers have an RRT on staff which allows the DME supplier to have non-RTs set up new patients w/their CPAPs using just the Quick Setup Guide and doing mask fittings, etc. Supposedly this is being done under the supervision of the on-staff RRT - who isn't even on the premises when it is being done. Our phlebotomists are not allowed to do an ABG - only an RRT or an ER doctor can do them at our hospital.

WHENEVER I meed an RRT or an RPSGT I try to take advantage of as much conversation as time allows. Which is why I appreciate your posts. It NEVER hurts to hear BOTH sides of an issue.

• ▶ Reply

Permalink Reply by RockRpsgt on July 1, 2009 at 5:39pm

More education and credibility in the field is a must. I agree. I am one of those that came from the "all walks of life" catagory. I won't lie my training was rough. I felt as though I was isolated on the island of sleep with the pappy mill that i began this journey with. Had it not been for sites like this one and binary along with a few individuals that noticed me. I don't know if I would have continued in sleep.

I believe that sleep involves some different aspects of a couple different sects of the medical industry. I also believe that sleep is too big to be a sub-specialty of any one of those sects. I am sure that your background in medicine has helped you in sleep. I have said it before the best labs will employ a wide variety of medical credentials including but not limited to RPSGT, RT,RRT, CRT, REEGT, and the always sought after RN. The education that I have received by being able to work with several different people with varias training has been priceless. Thanks for the debate Cindy and Welcome to sleepguide.

• ▶ Reply

▶ Reply to Discussion

• ‹ Previous
• 1
• 2
• 3
• 4
• Next ›
• Page