To Score or Not to Score
There has been a debate about scoring on the fly for as long as I can remember. In sleep labs, there are some who say it is great because it saves paying for another staff member to do it, it saves time and it allows the person who is doing the study to know exactly what is going on and whether or not to do a split-night study.
There are others who say that having a separate person score allows for better quality control, not reading things into the study and better overall care because the techs running the study do not have to split their attention.
But today really taught me why I hold the opinions I now do.
I have had a long couple of hectic weeks because of a series of incidents I had no control over. I had one technician end the night by leaving in an ambulance; and that very same week, another technician ended up with swine flu. That is how I ended up switching between days and nights. It is also how I ended up scoring on the fly. Not that I minded doing it because it does keep me busy and makes the night go faster. It also gives me a chance to look at something I might have missed running live.
What I found was that when I reviewed one of the studies a couple of days later, there were several things I missed. Now it could have happened because I came to work after I had worked a day shift. And the errors did occur in the second part of the study. I know for a fact that 3 a.m. is not my finest hour. But when I reviewed the study, I found I had missed several arousals and an artifact that had the computer scoring snores that did not exist.
In the grand scheme of things, I do not believe these mistakes really changed the final evaluation of the patient very much. The fact that my scoring was not up to par reminded me why I prefer scoring separately rather than on the fly.
I hate to admit that I am not perfect. I despise the fact that I make mistakes because I am just too tired sometimes. The fact is I can multitask only so much, and then something has to give. My priority is to care for the patient optimally, and each lab owner and manager needs to decide what is best for that lab.
At any rate, the debate will go on until some association states unequivocally that it has the right answer.