Patient Acceptance Fact Sheet

Applicable Accreditation Standards

Facilities must maintain a Policy and Procedures Manual that addresses patient acceptance policies for in-center testing. Written policies for patient acceptance must include:

  • Adherence to all applicable, current AASM guidelines:
  • Age limitations;
  • A mechanism for acceptance;
  • Evidence based criteria for exclusion; and
  • Information required from a referring health care provider prior to all sleep testing.

Facilities must demonstrate their acceptance and testing of patients with the full spectrum of sleep diagnoses as delineated by the current edition of the International Classification of Sleep Disorders. The testing portion of this standard can be met by providing a list of diagnoses or tests performed over a period of at least six months.

Facilities must maintain a Policy and Procedures Manual that addresses evidence based patient acceptance policies for HSAT. Written policies for patient acceptance must include:

  • Adherence to all applicable, current AASM guidelines; If the AASM guidelines are not used, as in the case of insurance mandate or medical exception, then a written protocol explaining acceptance criteria, rationale, and follow-up procedure on negative tests and positive tests must be in place;
  • Age limitations;
  • A mechanism for acceptance;
  • Evidence based criteria for exclusion; and
  • Information required from a referring health care provider prior to all sleep testing.

For patients directly referred, the facility director or appropriately licensed medical staff member must review the information provided for each patient and determine if the requested test is indicated according to Standard C-1/C-2. Evidence of communication with the referring clinician should be recorded in the patient record for every PSG or HSAT. This should include a history and physical received from the referring clinician and a sleep study report sent back to the referring clinician.

Patient Acceptance Policy

Explicit acceptance criteria for defining the patient population evaluated at the sleep facility ensures all patient evaluations are within the scope of the professional expertise, technical competence, capability of the staff and appropriate for the facility.

Requirements for Both In-Center and HSAT

This policy should be comprehensive and describe:

  • Types of patients accepted or Scope of Diagnostic Sleep Disorders.
  • Accepted patients adhere to the current AASM clinical guidelines and practice parameters
  • Age limitations.
  • Explanation of how referrals are received.
  • Information required from referring physician for those directly referred.
    • Recommend including a statement if Direct Referrals are not accepted.
  • The process of how patient information is reviewed and approved, to ensure the test is appropriate for the patient.
  • Evidence based criteria that may exclude a patient. (e.g. infectious disease, etc.)

Requirements Specific for HSAT

The HSAT policy should clearly define:

  • Only to be used for patients with high pre-test probability of OSA.
  • Not appropriate for patients under the age of 18.
  • Evidence based criteria for exclusion. This may include:
    • Limited co-morbidities, such as: moderate to severe pulmonary disease, neuromuscular conditions, congestive heart failure. Other sleep disorders such as: central sleep apnea, periodic leg movement disorder (PLMD), circadian rhythm disorder (CRD), narcolepsy, parasomnias.
    • HSAT should not be used for general screening

Key Things to Keep In Mind

  • If the sleep clinic and associated lab do not have direct access to information, it is necessary to have an affiliation/relationship whether formal or informal to allow access to information.
  • For clinics and labs in separate locations without direct access:
    • There must be a method of how the sleep facility gets information on PAP assessment/compliance to ensure standard H-2 is met.
    • There must be a method of data collection for QA reporting on the clinical Outcome and Process metrics.
    • Regardless of the location for the clinic (i.e. within the center, or in a physician’s separate office), it is still considered part of the sleep facility and must provide information required for the sleep facility as a whole to meet all accreditation standards.
      • If separate medical records are maintained at the sleep clinic and separate medical records are maintained at the sleep lab; at time of the site visit both will be reviewed and considered as one whole comprehensive medical record.