RPSGT Quality Assurance & Improvement Practice Questions — 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.

Question 8: A technologist notices that EEG electrode impedances are consistently elevated at the F7 and F8 sites for the past three patients. What is the BEST quality improvement action?

Document the findings and continue testing
Inspect and clean the electrode application equipment and technique (Correct answer)
Switch to a different electrode type without further investigation
Notify the scoring physician immediately

Correct answer: Inspect and clean the electrode application equipment and technique

Recurring high impedance at specific sites suggests a systematic issue with equipment or technique that should be identified and corrected.

Question 9: Which metric is MOST useful for tracking the percentage of studies that meet AASM minimum technical standards?

Average lights-off time
Study adequacy rate (Correct answer)
Equipment downtime percentage
Average technologist hours per study

Correct answer: Study adequacy rate

Study adequacy rate directly measures the proportion of studies meeting minimum technical criteria, making it the primary QA metric for technical quality.

Question 10: During a QA review, a lab finds that 20% of portable (OCST) studies have missing flow signal data. What should be the FIRST corrective step?

Switch vendors immediately
Conduct root-cause analysis to identify why flow signals are failing (Correct answer)
Eliminate OCST studies from the lab's offerings
Score the affected studies using oximetry alone

Correct answer: Conduct root-cause analysis to identify why flow signals are failing

Root-cause analysis identifies whether the failure stems from equipment, patient setup, patient behavior, or protocol gaps before implementing a fix.

Question 11: Which of the following BEST describes the purpose of inter-rater reliability testing in a sleep lab?

To ensure patients receive consistent billing
To measure agreement between technologists or scorers on the same study (Correct answer)
To compare a lab's equipment to manufacturer specifications
To track the number of patient complaints per quarter

Correct answer: To measure agreement between technologists or scorers on the same study

Inter-rater reliability testing quantifies how consistently different scorers apply AASM scoring rules to the same polysomnographic data.

Question 12: A sleep lab is implementing a CPAP adherence follow-up protocol. Which QA measure BEST evaluates the protocol's effectiveness?

Number of CPAP devices dispensed per month
Percentage of patients achieving ≥4 hours of nightly CPAP use at 90 days (Correct answer)
Average AHI reduction from diagnostic study
Technologist satisfaction scores with the new protocol

Correct answer: Percentage of patients achieving ≥4 hours of nightly CPAP use at 90 days

Measuring the percentage of patients achieving the standard adherence threshold at 90 days directly evaluates whether the follow-up protocol improves patient outcomes.

Question 13: A new scoring technologist is added to the team. What QA process BEST ensures their scoring meets lab standards?

Assign them independent overnight studies immediately
Perform calibration scoring on a set of known studies and review discrepancies (Correct answer)
Have them shadow another technologist for one night
Compare their reports to the referring physician's clinical notes

Correct answer: Perform calibration scoring on a set of known studies and review discrepancies

Calibration scoring on studies with known agreed-upon results provides objective feedback on whether the new scorer applies rules correctly.

Question 14: Which statement BEST reflects the role of a physician medical director in sleep lab quality assurance?

The medical director only signs off on final reports and has no QA role
The medical director provides clinical oversight, reviews QA data, and approves corrective action plans (Correct answer)
The medical director is responsible solely for billing compliance
The medical director's QA role is fulfilled by attending quarterly meetings only

Correct answer: The medical director provides clinical oversight, reviews QA data, and approves corrective action plans

AASM accreditation standards require the medical director to have an active clinical oversight role including reviewing QA metrics and approving improvement plans.

Question 15: Under AASM standards, how often should a sleep lab's quality improvement program formally review its outcome data?

Daily
Monthly
At least quarterly (Correct answer)
Annually only

Correct answer: At least quarterly

AASM accreditation requires that quality data be reviewed at least quarterly by the QA committee to ensure timely identification and response to problems.

Question 16: A lab adds a new HSAT device to its fleet. What QA step is MOST important before using the device on patients?

Inform the referring physicians of the new device
Perform equipment validation testing against a known standard or concurrent PSG (Correct answer)
Update the lab's patient consent forms
Register the device with the state health department

Correct answer: Perform equipment validation testing against a known standard or concurrent PSG

Validation testing confirms that the new device performs comparably to accepted standards, ensuring clinical validity before it is used for diagnostic purposes.

Question 17: Which corrective action is MOST appropriate when QA audits reveal that technologists are inconsistently applying AASM arousal scoring rules?

Retire the current scoring manual
Conduct targeted scoring calibration sessions using consensus-scored training records (Correct answer)
Switch to automated scoring software exclusively
Remove scoring responsibility from technologists

Correct answer: Conduct targeted scoring calibration sessions using consensus-scored training records

Calibration sessions with consensus-scored records directly address inconsistency by aligning technologist interpretation with the established standard.

Question 18: A sleep lab is preparing for AASM re-accreditation. Which document is MOST critical to demonstrate an ongoing QA program?

Original equipment purchase orders
QA meeting minutes and corrective action logs from the past accreditation cycle (Correct answer)
Technologist licensure certificates
Patient intake forms

Correct answer: QA meeting minutes and corrective action logs from the past accreditation cycle

QA meeting minutes and corrective action logs provide documented evidence that the lab has been continuously monitoring quality and responding to identified issues.

Question 19: What is the primary purpose of conducting a 'sentinel event' review in a sleep lab?

To comply with state licensing renewal requirements
To perform an in-depth analysis of a serious adverse event and prevent recurrence (Correct answer)
To satisfy insurance auditors requesting clinical documentation
To evaluate technologist performance for annual reviews

Correct answer: To perform an in-depth analysis of a serious adverse event and prevent recurrence

Sentinel event review is a root-cause analysis process focused on understanding system failures that led to a serious event and implementing safeguards to prevent it from happening again.

Question 20: Which statistical concept helps distinguish between 'common cause' and 'special cause' variation in a sleep lab's PSG quality metrics?

Mean absolute deviation
Statistical process control (SPC) charts (Correct answer)
Chi-square testing
Linear regression analysis

Correct answer: Statistical process control (SPC) charts

SPC control charts use statistically derived control limits to identify whether variation in a metric is random (common cause) or due to a specific identifiable factor (special cause).

Question 21: A lab finds that studies ordered by one particular referring practice have a significantly higher rate of incomplete data. What is the BEST QA response?

Stop accepting referrals from that practice
Share deidentified data with the practice and collaborate on pre-study patient education improvements (Correct answer)
Score incomplete studies using surrogate channels only
Flag the studies for secondary physician review without addressing the root cause

Correct answer: Share deidentified data with the practice and collaborate on pre-study patient education improvements

Collaborating with the referring practice on patient preparation addresses the upstream root cause and improves quality while preserving the referral relationship.

RPSGT Quality Assurance & Improvement Practice Questions

A sleep center wants to reduce patient 'no-show' rates for overnight studies.
Which QA approach is MOST systematic?

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