Independent Health Facilities “Clinical Practice Parameters and Facility Standards for Sleep Medicine”

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    In accordance with the College’s regular review cycle, the Independent Health Facilities (IHF) program’s “Clinical Practice Parameters and Facility Standards for Sleep Medicine” have been updated.  The document is designed to assist physicians in their clinical decision-making by providing a framework for assessing and treating clinical conditions in sleep medicine facilities.

    The College is inviting feedback from the profession and other relevant stakeholders on the updated draft IHF Clinical Practice Parameters and Facility Standards for Sleep Medicine , which is an update to the 2013 document.   

    Background

    The primary purpose of this document is to assist physicians in developing their own quality management program and act as a guide for assessing the quality of patient care provided in sleep medicine facilities.

    The Independent Health Facilities Act (IHFA) gives the College of Physicians and Surgeons of Ontario the primary responsibility for carrying out quality assessments in Independent Health Facilities, which includes responsibility for developing and regular updating of clinical practice parameters and facility standards.

    Key Features of the Revised Draft Parameters

    In addition to converting some former appendices into Chapters in the core document, the following key changes were made:

    • Statements and tables are embedded throughout the document to clarify content that should be recognized as a “Standard” versus a “Guideline”; the definition of a “Standard” and “Guidelines” (which are included in the Preface of the core document), are as follows:
      • A Standard is a generally accepted patient care strategy that reflects a high degree of clinical certainty.
      • A Guideline is a generally accepted patient care strategy that reflects a moderate degree of clinical certainty. Guidelines may be adopted, modified, or rejected according to clinical needs, individual patient considerations, local resources, and physician discretion. Guidelines do not establish inflexible protocols for patient care nor are they meant to replace the professional judgment of physicians.
    • Chapter 2: Staffing a Facility – Qualifications and training criteria for Technical Staff have been clarified (2.11.2.3).
    • Chapter 3:  Policies and Procedures – Facilities must have written policies that address the following: Management and mandatory reporting of patients to the Ministry of Transportation (3.2.1), and Appointment and role of Quality Advisor (3.2.2).   The link to the Provincial Infectious Diseases Advisory Committee (PIDAC) Infection Prevention and Control for Clinical Office Practice document (revised in April 2015) has been updated.
    • Chapter 5:  Requesting and Reporting Mechanisms – It is acknowledged that while automated scoring systems have improved, none of the currently available systems have sufficient peer-reviewed published assessment to allow adoption by Sleep facilities (5.4.3); Minimal standards for a Sleep Study Report has been updated (5.5.1).
    • Chapter 6:  Quality Management – Quality management goals have been enhanced (6.2); standards relating to records review have been modified (S6.3.9, S6.3.10 and S6.3.11).
    • Chapter 7:  Performance, Diagnosis and Management of Pediatric Sleep Related Disorders  – The unique needs of pediatric patients have been emphasized, as well as definitions for specialized pediatric centre, and pediatric sleep facility have been included (7.2).
    • Chapter 8:  Sleep Facility Requisitions:   Necessary Elements – Each facility maintains a separate requisition for each type of study (Overnight Sleep Studies (Polysomnograms or PSGs), Studies assessing drowsiness, etc.
    • Chapter 9:  Scoring Specifications- have been updated to align with the American Academy of Sleep Medicine Manual of the Scoring of Sleep and Associated Events version 2.3 (April 2016)
    • Chapter 10: Normative Data for Sleep in Adults and Pediatric Patients – Pediatric normal values are now included, and references for normative data have been updated.
    • Chapter 11:  Basic Guidelines for the Facility Titration of Positive Airway Pressure in Adults with Obstructive Sleep Apnea Syndrome – references are updated; Guidelines for Supplemental Oxygen administration have also been enhanced.
    • Chapter 12:  Recommended Variables Required in a Sleep Consultation Report – suggested core elements have been significantly expanded.
    • Chapter 13:  Sleepiness and Driving: Patient assessment, Patient Education and Obligations to Report – major changes have been made, such as:  clarity on existing laws and proposed laws for reporting; the task force’s views on what the sleep clinician’s role is in developing their medical opinion and in educating the sleep patient (13.3); reporting guidelines recommended by the Task force (13.4)
    • Chapter 14:  Portable Monitoring – this new Chapter addresses the use of unattended portable monitoring (portable sleep testing) as a diagnostic option for suspected OSAS in patients; content is based on the Canadian Sleep Society and Canadian Thoracic Society position paper, which has been adapted for Ontario.
    • Chapter 15:  Telemedicine – this new Chapter outlines the standards and guidelines for telemedicine.
    • Appendix III: Referral Update Form – this form, which is referenced in Chapter 3 under Policies and Procedures, is provided as a means to manage patients declining assessment or therapy.
    • Appendix IV:  Information on CPAP/Bilevel Access for patients – This form, which is referenced in Chapter 5 (see 5.6) requires that the facility make the patient aware of the ADP program and request them to sign a document demonstrating their awareness that they can go to a vendor of their choice.
    • Appendix VIII:   Sample Portable Sleep Apnea Test Requisition –  appropriate documentation that meets the requirements in Chapter 14 (where this form is referenced as a sample) need to be maintained by the facility performing the testing.

    Have Your Say

    The College welcomes feedback from members of the profession and any other stakeholders who wish to comment or propose revisions to the draft IHF Clinical Practice Parameters and Facility Standards for Sleep Medicine.  Please be sure to quote the specific Chapters and subsections to which your comments relate when providing feedback.

    Next Steps

    Feedback provided on the draft IHF Clinical Practice Parameters and Facility Standards for Sleep Medicine will assist the College in determining what revisions may be required.  Once the document is finalized, it will be posted to the CPSO website.

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    Attention: IHF Sleep Medecine