1350 Types of Nonconformance in the Accreditation of Home Sleep Apnea Testing in British Columbia, Canada

Abstract Introduction British Columbia is one of only two provinces in Canada that mandate accreditation for HSAT facilities. After achieving provisional accreditation by passing a desktop audit, 151 facilities became eligible to obtain full accreditation. This study examines the types of nonconformance identified during the full on-site assessment process. Methods Between 2022 and 2024, 95 facilities (62.9%) underwent on-site visits, which involved formal interviews with management and staff, evidence review, patient set-up observation, evaluation of ten clinical cases (final report packages), assessments of physical space, safety measures, and scoring quality. The process followed a standardized protocol based on 329 standards published in 2021 (1). The assessment results identified areas of nonconformance that facilities needed to address to achieve full accreditation. Results By December 2024, 95 out of 151 facilities in British Columbia (62.9%) had completed the accreditation process, with a total of 916 nonconformance issues identified during on-site assessments. These nonconformance issues were categorized as follows: procedural and documentation areas: 219 (23.8%); human resources standards: 139 (15.2%); medical director’s duties: 114 (12.5%); ethical standards: 76 (8.3%); HSAT equipment evaluation and maintenance: 66 (7.2%); reporting standards: 54 (5.9%); scoring and Interpretation: 46 (5.0%); client complaints and; feedback requirements: 45 (4.9%); safety and privacy: 38 (4.2%); patient communication: 32 (3.5%); technical HSAT Issues: 26 (2.8%); test appropriateness, infection prevention, and information management: 61 (6.7%) combined. This analysis shows that procedural and documentation issues were the most common area of nonconformance, followed by human resources standards and the medical director’s duties. We found that 10 out of 95 HSAT facilities (10.5%) fully met the current HSAT accreditation standards without any outstanding requirements. Conclusion Independent HSAT facilities are still essential in delivering diagnostic sleep services in British Columbia. These facilities have continuously embraced the accreditation process to enhance patient care and safety. This study, which presents the initial experience with the HSAT accreditation process, aims to pave the way for future research into the positive impact of accreditation programs on public health outcomes. Support (if any) Reference: 1. College of Physicians and Surgeons of British Columbia. (2021). Home Sleep Apnea Testing. Accreditation Standards, Version 1.0. https://www.cpsbc.ca/files/pdf/DAP-AS-Home-Sleep-Apnea-Testing-V1.0.pdf