This is the final blog in our 6-part Accreditation Hack Series. It’s been great sharing our time saving hacks and our tips to streamline the accreditation process. By now you may have noticed one thing… here at CardioServ we love what we do! We are passionate about improving the quality of diagnostic imaging. It’s this passion that drives us to be relentless with our pursuit of excellence and steadfast in our commitment to improving the accreditation process for the diagnostic community. We believe in using an innovative process to give you a strategic advantage to successful accreditation.

In the past few weeks we have shared tips for streamlining:

• Report Review
• Technical Measure
• Interpretive Quality
• Clinical Correlation

This now just leaves test appropriateness and planning your Quality Improvement Measures. So let’s jump right in!

TEST APPROPRIATENESS

Test appropriateness is a mandated measure across all modalities. Only echo and nuclear require a specific number that must be reviewed, the other modalities allow you to select how many reports to review. Currently IAC does not have a detailed process that must be followed but rather just requires that you evaluate the appropriateness of the test being performed and categorize them as:

• appropriate
• may be appropriate
• rarely appropriate

So how do you determine test appropriateness? The American College of Cardiology has written Appropriate Use Criteria Papers that outline the appropriateness of indications based on the patients’ history and symptoms. There are algorithms that are used to determine test appropriateness. Unfortunately the document is long (40 pages) and not easy to quickly navigate. A simple rule of thumb to guide you in the assessment of the AUC is to remember that for indications to be considered appropriate they usually include:

• signs and symptoms
• change in clinical status
• to guide therapy

Here is a sample from the Appropriate Use Criteria document for echocardiography with an indication of aortic stenosis:

Using this example of aortic stenosis, tracking your indications will go one of two ways. You have just pulled 30 reports and you sit down to assess the test appropriateness.

Scenario 1:

Facility: Dream Clinic
Physician: Dr. Perfect
Indication: Aortic Stenosis
Patient History: Patient has known mild aortic stenosis with last exam performed 4 years ago. Echo was ordered to re-evaluate the severity of aortic stenosis.

Scenario 2:

Facility: Reality Clinic
Physician: Dr. Real
Indication: Aortic Stenosis

As most of us work at Reality Clinic and not Dream Clinic you can see how hard it is to assess the appropriateness of the indication. The appropriateness of Aortic Stenosis depends on many factors including severity, time since last echo, change in clinical status, etc. Any one of these factors will change the grading from inappropriate to appropriate.

HACK #1: GET IN FRONT OF IT!

By the time you sit down to assess appropriateness it’s too late to guide the physician on correct ordering practices so get in front of it! Implement changes in your practice in regards to the ordering process.

Manual Orders

Create order sheets that make it easy for the physician to provide the additional information needed. Here is a section from the sample order form that ACC provides on their website:

Electronic Orders

The same concept applies but just electronically. Provide as many drop down menus and check boxes as necessary to allow the physician to easily enter additional and necessary information. For many clients that worked in hospitals with limited ability to manipulate the order entry systems they simply added an additional field and made it mandatory to answer before the order could be completed. Using the example of ordering an echocardiogram the doctor would enter their indication as usual and then answer a follow up question (the additional field) which includes these 4 options:

1. Patient presented with cardiac signs and symptoms
2. Patient has change in clinical status
3. Exam needed to guide therapy
4. If none of the above please explain (free type field appears)

You would be surprised how these 4 magic questions will make your life easier and test appropriateness significantly increase!

QUALITY IMPROVEMENT MEETINGS

The new standards now only requires a minimum of 2 meetings per year but most QI measures are still quarterly so many institutions still maintain 4 meetings a year, especially at facilities that complete their peer review as a group during the meetings

HACK #2: BECOME A SCHEDULING GURU!

Early in the year it’s a good idea to schedule your Quality Improvement Meetings so that you can post the dates and make the physicians and technical staff aware of the dates. Here are some secrets to successful scheduling that are great for larger institutions juggling many physicians. These are 5 things to check before scheduling your meetings to help increase the attendance:

1. Google a calendar that includes all holidays (government, school, Christian, Jewish, Muslim, etc.) so that you do NOT schedule a meeting on any holiday that would prevent staff from attending.
2. Check out the dates of large medical conferences. For example, if your physicians are cardiologists check the dates of the big cardiology conferences (ACC, ASE, Mayo, Cleveland Clinic etc.)
3. Check the schedule of your own facility for other conflicting meetings. We have learnt the hard way and found out we were holding our Echo Meeting the same day the hospital was holding a Medical Staff Meeting.
4. Check the schedule of the other local hospitals where your physicians practice. Believe it or not we had our Echo meeting scheduled the same night as another area hospitals echo meeting and the cardiologists were required at both meetings
5. Ask if anyone is aware of vacation time they will be taking. If many staff members take off in the summer try and avoid those months. We hold our 2nd quarter meetings early in the quarter and the 3rd quarter meeting late in the quarter to avoid the summer vacations

GRADUATION

So you are now ready to graduate as a Quality Improvement Expert! Over the past 6 weeks you have reviewed the new QI requirements and learnt hacks to mastering each measure. By now you would have noticed that the common theme to timesaving hacks is breaking down each task into smaller manageable tasks and having the correct resources to make the task a breeze. I will leave you with one last parting hack.

HACK OF ALL HACKS: THE RIGHT TOOL FOR THE RIGHT JOB

We have all heard the expression “the right tool for the right job”, usually from our grandfathers! This common sense advice also applies to completing your Quality Improvement Measures. The importance of the right tool for a job is even more critical when it’s for a task that you have to complete repeatedly!

Make sure you have the right tools to allow for the easy completion of each QI measure. You have a few options:

• Accreditation Software
  Invest in a product that is easy, efficient and effective at quickly completing your Quality Improvement Measures. Watch a product tour of AccreditCoach to see how it can help!
• QI Resources
  Buy a complete set of QI forms and receive weekly eTutoring to keep you on track
  Coming soon in the next few weeks! Sign up for our newsletter to be notified immediately when they become available!
• Create your own complete set of QI forms and make a schedule
  By taking the time to gather all the necessary tools and laying out a set schedule you will set yourself up for success

We have thoroughly enjoyed sharing some or our accreditation experience with you. Please feel free to contact us anytime with questions. CardioServ is excited that we are changing the way you achieve accreditation!