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QA and CQI:QA and CQI:How?How?
Merri L. Bremer MEd, RN, RDCS, FASEMerri L. Bremer MEd, RN, RDCS, FASE
DisclosuresDisclosures
Relevant RelationshipMember, ICAEL Board of Directors
Off Label UsageNone
Learning ObjectivesLearning Objectives
Define QADefine QA
Discuss ideas for development and Discuss ideas for development and implementation of Echo Lab QAimplementation of Echo Lab QA
QA: What is it?QA: What is it?
Many names (QA, QI, CQI)Many names (QA, QI, CQI)
Method of continuously Method of continuously examining processes and examining processes and making them more effectivemaking them more effective
Focus is on Focus is on the processthe process, not the , not the individualindividual
QA: What is it not?QA: What is it not?
PunitivePunitive
DemeaningDemeaning
DemoralizingDemoralizing
DivisiveDivisive
BusyworkBusyworkOR…..OR…..
When you watch me,
they want me to do it
differently…
BenefitsBenefits
Develops and maintains Develops and maintains quality in your practice quality in your practice
Ensures uniform, consistent Ensures uniform, consistent standards for interpretation and standards for interpretation and reportingreporting
Excellent Excellent continuingcontinuing educationeducation tooltool
Standards and GuidelinesStandards and Guidelines
ICAEL StandardsICAEL Standards
ASE Guidelines and StandardsASE Guidelines and Standards
SDMS Position StatementsSDMS Position Statements
ASE Sonographer Minimum ASE Sonographer Minimum StandardsStandards
ICAEL QA ComponentsICAEL QA Components
Written policyWritten policy
AUCAUC
Instrument Instrument maintenancemaintenance
Procedure Procedure volumesvolumes
CMECME
Peer reviewPeer review
CorrelationCorrelation
Report Report TimelinessTimeliness
ConferencesConferences
Record Record keepingkeeping
Writing a QA PolicyWriting a QA Policy
Identify required elements Identify required elements (ICAEL (ICAEL Standards)Standards)
Figure out how Figure out how YOUR TEAMYOUR TEAM can can accomplish them and write them accomplish them and write them downdown
Sample policies on ICAEL websiteSample policies on ICAEL website
Try them….revise and try again if Try them….revise and try again if necessarynecessary
Communicate! Frequently!Communicate! Frequently!
Appropriate Use Criteria (AUC)Appropriate Use Criteria (AUC)
Mandatory requirement for accreditation Mandatory requirement for accreditation effective effective January 1, 2012January 1, 2012
Appropriate use must be measured in a Appropriate use must be measured in a minimum of 30 consecutive TTE, 30 minimum of 30 consecutive TTE, 30 consecutive TEE and 30 consecutive Stress consecutive TEE and 30 consecutive Stress patientspatients annually annually ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 Appropriateness Criteria for Transthoracic and Appropriateness Criteria for Transthoracic and Transesophageal EchocardiographyTransesophageal Echocardiography
Percentage of appropriate, inappropriate and Percentage of appropriate, inappropriate and uncertain indications for testing must be uncertain indications for testing must be measuredmeasured
Appropriate Use CriteriaAppropriate Use Criteria
A program for education and reporting must A program for education and reporting must be developed and include:be developed and include:– Baseline rates of adherenceBaseline rates of adherence– Patterns of adherence Patterns of adherence – Goals for improvement Goals for improvement – Measurement of improvement Measurement of improvement – Confidential reports on patterns of adherence Confidential reports on patterns of adherence
Ordering physicianOrdering physician
Ordering practice Ordering practice
Interpreting practiceInterpreting practice
Instrument MaintenanceInstrument Maintenance
Recording of method and frequency of Recording of method and frequency of maintenance maintenance
Establishment of and adherence to a Establishment of and adherence to a policy regarding routine safety policy regarding routine safety inspections and testing of all laboratory inspections and testing of all laboratory electrical equipmentelectrical equipment
Establishment of and adherence to an Establishment of and adherence to an instrument cleaning scheduleinstrument cleaning schedule
Instrument MaintenanceInstrument Maintenance
Use institutional resources if you Use institutional resources if you have themhave them
If you don’t have them, create a If you don’t have them, create a policy using the manufacturer’s policy using the manufacturer’s guidelines and follow itguidelines and follow it
Ask your equipment reps for help!Ask your equipment reps for help!
Maintenance LogMaintenance Log
Procedure VolumesProcedure VolumesAnnual individual and laboratory statsAnnual individual and laboratory stats
Records of individual procedure Records of individual procedure volumes should include volumes from volumes should include volumes from all laboratories where staff all laboratories where staff perform/interpret echocardiogramsperform/interpret echocardiograms
Methods of tracking Methods of tracking – ScheduleSchedule– Procedure listProcedure list– BillingBilling
Sonographer Procedure Volume Sonographer Procedure Volume LogLog
MD Procedure Volume LogMD Procedure Volume Log
CMECME
Documentation of echocardiography-Documentation of echocardiography-related continuing education for all related continuing education for all medical and technical personnel medical and technical personnel mustmust be be maintainedmaintained
Keep in central location; update annuallyKeep in central location; update annually
Materials Materials – CD, journal, Internet, videotape materials CD, journal, Internet, videotape materials – Departmental, local, regional and national Departmental, local, regional and national
conferences and coursesconferences and courses
CMECME
15 15 echo-relatedecho-related CME credits required CME credits required for all staff (3 year period)for all staff (3 year period)
Category 1 AMA creditCategory 1 AMA credit
Other approved non-category 1 Other approved non-category 1 credit (ASE, SDMS or ARRT) that credit (ASE, SDMS or ARRT) that have have content specific to content specific to echocardiographyechocardiography
CME LogCME Log
Peer ReviewPeer Review
Feedback is essential for Feedback is essential for improvement!improvement!
Intermittent peer review of both Intermittent peer review of both performance and interpretation of performance and interpretation of studies studies shouldshould be performed be performed
Optional QA measure, but very usefulOptional QA measure, but very useful
Both physicians and sonographers Both physicians and sonographers should be involved should be involved
Peer ReviewPeer Review
Differences in interpretation styles Differences in interpretation styles and performance should be and performance should be reconciled reconciled
Individual vs group reviewsIndividual vs group reviews
Confidentiality Confidentiality
Document it!Document it!
MD Peer Review MD Peer Review
Variability
EF, wall motion analysis and degree of regurgitation/stenosis must be assessed on a minimum of two cases per modality per quarter to be reviewed in quarterly conferencesRepresent as many physicians as possiblePolicy to address discrepancies
Variability WorksheetVariability Worksheet
Variability SummaryVariability Summary
CorrelationCorrelation
EF, wall motion analysis and degree of regurgitation/stenosis will be correlated on a minimum of two per modality per quarter with other imaging modalities in quarterly conferences Represent as many physicians as possiblePolicy to address discrepancies
http://www.icael.org/icael/pdfs/Correlation_Form.pdf
Report ReviewReport ReviewMinimum of 10 random reports per quarter Time from performance of study to report sign-off– Inpatient: 24 hours– Outpatient: end of next business dayReport completeness (Standards)Represent as many physicians as possiblePolicy to address discrepancies
QA Conferences QA Conferences
Quarterly conferences Quarterly conferences mustmust be held be held to review the results of variability, to review the results of variability, correlation and report timelines, to correlation and report timelines, to address discrepancies and to discuss address discrepancies and to discuss difficult casesdifficult cases
Attendance by the medical and Attendance by the medical and technical directors or their designees technical directors or their designees is required at all meetingsis required at all meetings
QA Conferences QA Conferences
All medical and technical staff are All medical and technical staff are required to required to attend at least two of the attend at least two of the fourfour meetingsmeetings
Minutes of the meetings and Minutes of the meetings and attendance must be recordedattendance must be recorded
Record KeepingRecord Keeping
If you don’t document it, If you don’t document it, it didn’t it didn’t happenhappen
Keep data in a central location Keep data in a central location and and back it upback it up
Annual summary of information Annual summary of information requiredrequired
Requirements for SuccessRequirements for Success
Leadership Commitment
Commitment ofResources
IndividualCommitment
BUY-IN
Accreditation/QA ResourcesAccreditation/QA Resources
http://http://asecho.orgasecho.org//
http://http://www.icael.org/icael/index.htmwww.icael.org/icael/index.htm
http://http://www.sdms.orgwww.sdms.org//
http://www.asq.org/learn-about-quality/indhttp://www.asq.org/learn-about-quality/index.htmlex.html
Merri’s RulesMerri’s Rules for QAfor QA
Keep it Keep it SIMPLESIMPLE and practical and practical
Involve lotsInvolve lots of people and ideas of people and ideas
StealSteal shamelessly from others shamelessly from others
AdaptAdapt what you’ve stolen what you’ve stolen
Be methodicalBe methodical
Document Document
ShareShare what you’ve found what you’ve found