During a recent assessment of an adult sleep service, a discussion was held around the need to include TcCO2 as one of the recording parameters for this age group.
TcCO2 is short for transcutaneous carbon dioxide. It is a non-invasive way of assessing ventilation and oxygenation (i.e., whether a patient is taking in enough oxygen and expelling enough carbon dioxide) without the need to take a blood sample to measure this.
For studies which are Medicare funded, TcCO2 must be included for paediatric (12 < 18 year old) patients as this is explicitly described within the relevant Medicare item numbers.
The need to include TcCO2 where studies are not Medicare-funded, however, remained unclear.
Noting this, this question was asked of the Sleep Disorders Services Accreditation Advisory Committee (SDAAC) and the following was agreed to:
- The appropriateness of conducting studies on adolescents 15 years and over in an adult service should be made on a case-by-case basis by the physician responsible for reporting the study, and upon a review of all the relevant information, including the referral/clinical review of the patient.
It also needs to consider the following:
- Has the service assessed the risks in conducting the study in an adult service compared with those in a dedicated paediatric service and still meet the needs of the patient population?
- Are staff (physicians, scientists and/or nurses) appropriately trained and competent for this patient population?
- What are the technical limitations of the physiological variables utilised for the sleep study and the potential effects on patient outcomes/results?
- Who will be responsible for the management of this patient?
Once the sleep physician has decided the adult service is an appropriate provider, the adult ASA guidelines need to be applied to the study being undertaken.
Those facilities providing Medicare funded services to adolescent populations (15 – 17 year old’s) must ensure they are complying with the requirements as detailed in the MBS.
For more information on this change, please contact tracy.fleming@nata.com.au
