What is the intent of the ISR requirement?
The ISR program is an integral part of a facility’s quality assurance program. Close agreement of scoring personnel is necessary for accurate interpretation and quality patient management. Scoring technologists’ participation in an ISR program encourages continuous improvement of sleep scoring skills.
Which sleep facility staff members participate in ISR?
- All scoring technologists: Technical staff members who score sleep studies for the sleep facility. This includes:
- Technical staff members that score as little as one record and;
- Subcontracted scorers
- Reference Sleep Specialist: The facility director or medical staff member board-certified (individual meeting Standard B-2) serves as the facility’s reference sleep specialist.
- A corporate appointed board-certified sleep specialist that serves as the reference sleep specialist.
Details on conducting sleep facility ISR?
- Three polysomnograms (PSGs) must be compared using 200 consecutive epochs for a total of 12 polysomnograms per year.
- The facility’s reference sleep specialist and all scoring technologists must independently score the epochs for each polysomnogram used in the comparison.
- Scoring must include all four parameters: staging (epoch by epoch), respiratory events, leg movements and arousals.
- PSGs must report an acceptable level of agreement between each scorer and the reference sleep specialist (usually expressed as a percent).
- Comparison data must be tabulated for each of the four parameters compared indicating the acceptable level of agreement.
- The quarterly report should indicate whether each scoring technologist has met the goal percentage and, if not, what actions were taken to address inconsistencies.
- The quarterly report must be signed and dated by the reference sleep specialist indicating review and identify actions taken for corrections if necessary.
- For facilities using a corporate appointed reference sleep specialist, the facility’s director must attest in writing that the information has been reviewed.
AASM Sleep ISR Program: The AASM’s optional online mechanism for meeting the ISR accreditation standards.
The AASM posts a set of 200 epochs to the online Sleep ISR program each month that have already been scored by the AASM Gold Standard.
Participating facilities must have all scoring technologists score the 200 epochs.
The technologists’ scores are compared to the gold standard with a percentage level of agreement report generated.
The sleep facility’s reference sleep specialist must review their sleep technologists’ results and sign the report as part of the quarterly quality assurance program.
The Sleep ISR program, like accreditation, is location specific. This means although your staff completes their assessments, the assessments cannot count for or be combined with any other accredited facility.
Standard F-7 states that “ISR assessment must be conducted for each sleep facility”, therefore each accredited facility location has to purchase a separate, active ISR account to be in compliance.
Once each facility has established a separate, paid account you may link staff to each location. Linking Staff to each location ensures your staff only need to complete the monthly assessment one time and their score will be applied to each location to which they are linked.