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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)

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Qa and cqi how

QA and CQI:How?

Merri L. Bremer MEd, RN, RDCS, FASE


Disclosures
Disclosures

Relevant Relationship

Member, ICAEL Board of Directors

Off Label Usage

None


Learning objectives
Learning Objectives

Define QA

Discuss ideas for development and implementation of Echo Lab QA


Qa what is it
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

Lesson Learned


Qa what is it not
QA: What is it not?

Punitive

Demeaning

Demoralizing

Divisive

Busywork

OR…..



Benefits
Benefits

Develops and maintains quality in your practice

Ensures uniform, consistent standards for interpretation and reporting

Excellent continuingeducation tool


Standards and guidelines
Standards and Guidelines

ICAEL Standards

ASE Guidelines and Standards

SDMS Position Statements

ASE Sonographer Minimum Standards


Icael qa components
ICAEL QA Components

Written policy

AUC

Instrument maintenance

Procedure volumes

CME

Peer review

Correlation

Report Timeliness

Conferences

Record keeping


Writing a qa policy
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!

KISS

Lesson Learned


Appropriate use criteria auc
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

NEW!!


Appropriate use criteria
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

NEW!!


Instrument maintenance
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 maintenance1
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!



Procedure volumes
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

Lesson Learned




CME

Documentation of echocardiography-related 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

NEW!!



Peer review
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 review1
Peer Review

Differences in interpretation styles and performance should be reconciled

Individual vs group reviews

Confidentiality

Document it!

Lesson Learned



Variability
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

NEW!!




Correlation
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

NEW!!



Report review
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

NEW!!


Qa conferences
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 conferences1
QA Conferences

All medical and technical staff are required to attend at least two of the fourmeetings

Minutes of the meetings and attendance must be recorded


Record keeping
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

Lesson Learned

Lesson Learned

NEW!!



Accreditation qa resources
Accreditation/QA Resources

http://asecho.org/

http://www.icael.org/icael/index.htm

http://www.sdms.org/

http://www.asq.org/learn-about-quality/index.html


Merri s rules for qa
Merri’s Rulesfor 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


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