QA and CQI: How?

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QA and CQIHow?

• Merri L. Bremer MEd, RN, RDCS, FASE

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Disclosures

• Relevant Relationship
• Member, ICAEL Board of Directors
• Off Label Usage
• None

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Learning Objectives

• Define QA
• Discuss ideas for development and implementation
  of Echo Lab QA

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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
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QA What is it not?

• Punitive
• Demeaning
• Demoralizing
• Divisive
• Busywork
• OR..

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When you watch me, they want me to do it
differently
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Benefits

• Develops and maintains
  quality in your practice
• Ensures uniform, consistent standards for
  interpretation and reporting
• Excellent continuing education tool

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Standards and Guidelines

• ICAEL Standards
• ASE Guidelines and Standards
• SDMS Position Statements
• ASE Sonographer Minimum Standards

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ICAEL QA Components

• Written policy
• AUC
• Instrument maintenance
• Procedure volumes
• CME

• Peer review
• Correlation
• Report Timeliness
• Conferences
• Record keeping

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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
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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!!
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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!!
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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

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Instrument Maintenance

• Use institutional resources if you have them
• If you dont have them, create a policy using the
  manufacturers guidelines and follow it
• Ask your equipment reps for help!

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Maintenance Log
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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
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Sonographer Procedure Volume Log
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MD Procedure Volume Log
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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

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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!!
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CME Log
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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

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Peer Review

• Differences in interpretation styles and
  performance should be reconciled
• Individual vs group reviews
• Confidentiality
• Document it!

Lesson Learned
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MD Peer Review
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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!!
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Variability Worksheet
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Variability Summary
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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!!
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http//www.icael.org/icael/pdfs/Correlation_Form.p
df
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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!!
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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

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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

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Record Keeping

• If you dont document it, it didnt happen
• Keep data in a central location and back it up
• Annual summary of information required

Lesson Learned
Lesson Learned
NEW!!
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Requirements for Success
BUY-IN
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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

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Merris Rules for QA

• Keep it SIMPLE and practical
• Involve lots of people and ideas
• Steal shamelessly from others
• Adapt what youve stolen
• Be methodical
• Document
• Share what youve found