QA and CQI:
How?
Merri L. Bremer MEd, RN, RDCS, FASE
Disclosures
Relevant Relationship
Member, ICAEL Board of Directors
Off Label Usage
None
Learning Objectives
Define QA
Discuss ideas for development and
implementation of Echo Lab QA
QA: What is it?
Many names (QA, QI, CQI)
Method of continuously examining
processes and making them more
effective
Focus is on the process, not the
individual
QA: What is it not?
Punitive
Demeaning
Demoralizing
Divisive
Busywork
OR…..
When you
watch me,
they want me
to do it
differently…
Benefits
Develops and maintains
quality in your practice
Ensures uniform, consistent
standards for interpretation and
reporting
Excellent continuing education tool
Standards and Guidelines
ICAEL Standards
ASE Guidelines and Standards
SDMS Position Statements
ASE Sonographer Minimum
Standards
ICAEL QA Components
Written policy
AUC
Instrument
maintenance
Procedure
volumes
CME
Peer review
Correlation
Report
Timeliness
Conferences
Record keeping
Writing a QA Policy
Identify required elements (ICAEL
Standards)
Figure out how YOUR TEAM can
accomplish them and write them down
Sample policies on ICAEL website
Try them….revise and try again if
necessary
Communicate! Frequently!
Appropriate Use Criteria (AUC)
Mandatory requirement for accreditation
effective January 1, 2012
Appropriate use must be measured in a
minimum of 30 consecutive TTE, 30
consecutive TEE and 30 consecutive Stress
patients annually
ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR
2007 Appropriateness Criteria for Transthoracic
and Transesophageal Echocardiography
Percentage of appropriate, inappropriate and
uncertain indications for testing must be
measured
Appropriate Use Criteria
A program for education and reporting must be
developed and include:
–
–
–
–
–
Baseline rates of adherence
Patterns of adherence
Goals for improvement
Measurement of improvement
Confidential reports on patterns of adherence
Ordering physician
Ordering practice
Interpreting practice
Instrument Maintenance
Recording of method and frequency of
maintenance
Establishment of and adherence to a policy
regarding routine safety inspections and
testing of all laboratory electrical
equipment
Establishment of and adherence to an
instrument cleaning schedule
Instrument Maintenance
Use institutional resources if you have
them
If you don’t have them, create a policy
using the manufacturer’s guidelines and
follow it
Ask your equipment reps for help!
Maintenance Log
Procedure Volumes
Annual individual and laboratory stats
Records of individual procedure volumes
should include volumes from all
laboratories where staff
perform/interpret echocardiograms
Methods of tracking
– Schedule
– Procedure list
– Billing
Sonographer Procedure Volume Log
MD Procedure Volume Log
CME
Documentation of echocardiographyrelated continuing education for all
medical and technical personnel must be
maintained
Keep in central location; update annually
Materials
– CD, journal, Internet, videotape materials
– Departmental, local, regional and national
conferences and courses
CME
15 echo-related CME credits required
for all staff (3 year period)
Category 1 AMA credit
Other approved non-category 1 credit
(ASE, SDMS or ARRT) that have
content specific to echocardiography
CME Log
Name of Employee:
Sponsor
Date(s)
Location of CME Activity
Title
Total Hours
Credit Hours
Type of Credit (SDMS, Category I AMA, etc)
Peer Review
Feedback is essential for improvement!
Intermittent peer review of both
performance and interpretation of
studies should be performed
Optional QA measure, but very useful
Both physicians and sonographers should
be involved
Peer Review
Differences in interpretation styles and
performance should be reconciled
Individual vs group reviews
Confidentiality
Document it!
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
conferences
Represent as many physicians as
possible
Policy to address discrepancies
Variability Worksheet
Variability Summary
Correlation
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
possible
Policy to address discrepancies
http://www.icael.org/icael/pdfs/Correlation_Form.pdf
Report Review
Minimum of 10 random reports per quarter
Time from performance of study to report
sign-off
– Inpatient: 24 hours
– Outpatient: end of next business day
Report completeness (Standards)
Represent as many physicians as possible
Policy to address discrepancies
QA Conferences
Quarterly conferences must be held to
review the results of variability,
correlation and report timelines, to
address discrepancies and to discuss
difficult cases
Attendance by the medical and
technical directors or their designees is
required at all meetings
QA Conferences
All medical and technical staff are
required to attend at least two of the
four meetings
Minutes of the meetings and attendance
must be recorded
Record Keeping
If you don’t document it, it didn’t
happen
Keep data in a central location and
back it up
Annual summary of information
required
Requirements for Success
Leadership Commitment
BUY-IN
Individual
Commitment
Commitment of
Resources
Accreditation/QA Resources
http://asecho.org/
http://www.icael.org/icael/index.htm
http://www.sdms.org/
http://www.asq.org/learn-aboutquality/index.html
Merri’s Rules for QA
Keep it SIMPLE and practical
Involve lots of people and ideas
Steal shamelessly from others
Adapt what you’ve stolen
Be methodical
Document
Share what you’ve found