RPSGT Quality Assurance & Improvement 3 — Questions and Answers
Question 1: A sleep center wants to reduce patient 'no-show' rates for overnight studies. Which QA approach is MOST systematic?
- Call patients the day of the study as a reminder
- Analyze no-show data by day of week, referral source, and insurance type to identify patterns (Correct answer)
- Overbook appointments by 10% to compensate for no-shows
- Discharge patients who miss more than one appointment
Correct answer: Analyze no-show data by day of week, referral source, and insurance type to identify patterns
Stratified data analysis reveals which variables most strongly predict no-shows, allowing targeted interventions rather than blanket workarounds.
Question 2: Which tool is MOST appropriate for visually displaying the frequency of different categories of PSG technical defects to prioritize QA efforts?
- Control chart
- Pareto chart (Correct answer)
- Fishbone diagram
- Run chart
Correct answer: Pareto chart
A Pareto chart ranks defect categories by frequency, allowing a lab to focus on the 'vital few' problems that account for the majority of quality issues.
Question 3: What does 'PDSA cycle' stand for in the context of sleep lab quality improvement?
- Prevent, Detect, Score, Analyze
- Plan, Do, Study, Act (Correct answer)
- Process, Data, Standards, Audit
- Protocol, Documentation, Scoring, Assessment
Correct answer: Plan, Do, Study, Act
The PDSA (Plan-Do-Study-Act) cycle is a structured quality improvement methodology used to test changes on a small scale before full implementation.
Question 4: A sleep lab tracks its artifact rate over 12 months and finds a sudden spike in Month 8. What is the BEST initial action?
- Implement new electrode protocols lab-wide immediately
- Investigate what changed in Month 8 (staff, equipment, environment) to identify a cause (Correct answer)
- Dismiss the spike as statistical noise and continue monitoring
- Retrain all technologists on artifact prevention
Correct answer: Investigate what changed in Month 8 (staff, equipment, environment) to identify a cause
Identifying what specifically changed at the time of the spike (special cause variation) is essential before implementing any corrective action.
Question 5: Which AASM accreditation standard requires sleep labs to track patient satisfaction?
- Technologist staffing ratios
- Quality measures and outcomes (Correct answer)
- Equipment maintenance logs
- Physician credentialing requirements
Correct answer: Quality measures and outcomes
AASM accreditation standards require labs to measure quality outcomes including patient satisfaction as part of their ongoing quality program.
Question 6: A lab's QA committee reviews a case where a patient's AHI was scored as 4.8 on one reading and 18.2 on a second reading of the same night. What type of error does this MOST likely represent?
- Equipment calibration failure
- Scoring inconsistency or inter-rater variability (Correct answer)
- Incorrect patient identification
- Data acquisition artifact
Correct answer: Scoring inconsistency or inter-rater variability
A large discrepancy between two scorings of identical data strongly suggests inconsistent application of scoring rules, which is an inter-rater reliability problem.
Question 7: Which of the following is an example of a PROCESS measure (rather than an outcome measure) in sleep lab QA?
- Percentage of patients diagnosed with OSA
- Rate of CPAP adherence at 90 days
- Percentage of studies with electrode impedances below 5 kΩ (Correct answer)
- Number of patients referred back to the ordering physician
Correct answer: Percentage of studies with electrode impedances below 5 kΩ
Electrode impedance compliance is a process measure because it tracks whether the technical process was performed correctly, not the clinical result for the patient.
RPSGT Quality Assurance & Improvement 3
A sleep center wants to reduce patient 'no-show' rates for overnight studies.
Which QA approach is MOST systematic?