LEARN ACCREDITATION CONSULTANTS’ SECRET TO COMPLETING QI MEASURES

In our Accreditation Hack blog series we are revealing our strategies to help you accomplish compliance with all IAC mandated QI measures. Last week we provided 3 timesaving hacks to complete your Report Completeness measure with quality and ease. This week we will share 3 consultant secrets to complete both your technical and interpretive QI measures while keeping your sanity!

Remember each division of IAC now requires the following QI measures to be completed:

• Test Appropriateness
• Technical Quality
• Interpretive Quality
• Report Completeness
• Wild Card (Modality specific)

You are in the process of mastering the best way to complete Report Completeness; this week we will show you how to combine completion of your Technical Measure and Interpretive Measure to not only increase efficiency but also to yield impressive results of improved quality. Why are these two measures perfect for combining?

TECHNICAL AND INTERPRETIVE MEASURES…THE PERFECT PAIR!

The Technical Measure requires review of clinical images for clarity, completeness and adherence to quality while the Interpretive Measure must evaluate the quality and accurateness of the interpretation.
Simply put… both the performer of the test and the interpreter of the test should have their work checked for accurateness. None of the modalities, except Echocardiography, specify a required number of studies to review. Since Echo requires the review of 2 cases per testing area per quarter for both the Technical and Interpretive Measure we will follow that format.

As a quick side note – vascular, MRI and CT allows the interpretive measure to be completed via clinical correlation or peer review. As we are focusing this week on combining the Technical and Interpretive measures we will discuss clinical correlation tips later on in the blog series.

HACK #1: ASSIGN THE SAME 2 CASES TO EACH PHYSICIAN!

By assigning the same two cases to all physicians for review, you will be able to better assess variability within your lab. Did I mention this makes it easier too! We always recommend selecting abnormal studies if possible. Sure, you can review a normal study for proper interpretation but there is just so much more to learn about how a study with pathology was interpreted. Abnormal studies allow for greater learning opportunities. Looking for just 2 abnormal studies per testing area is a lot more doable!

But why not just have each physician over-read another physician? We have had clients tell us “at our facility we just have a physician select any study and then over-read it”. That’s ok but I would ask you to consider this scenario.

A group of 5 physicians participate in peer review. You have to select 2 different studies for each doctor to over-read – that’s 10 studies to select! Now imagine there is a discrepancy between the doctors. All you have at your fingertips is the original findings and the peer review findings. Who is right and who is wrong?? Hey Dr. Smith, Dr. Jones thinks the EF is 45% not 30%!

Now imagine this same group of 5 physicians participating in peer review with your new secret weapon of efficiency! You select only 2 cases and have each physician complete an over-read and alas, there is a discrepancy! Now you have actual variability data to present! You can present the 5 over-reads to the physician. Image how much more valuable this data is. Hey Dr. Smith, we reviewed a case and 4 out of 5 physicians interpreted the EF as 45% not 30%, would you like to review this study again? It’s easier for a physician to acknowledge a discrepancy when tracked against a group of his peers. You can even start to track if the same physicians consistently over call or under call pathology. All this is great information to help improve the quality of your lab.

HACK #2: REVIEW THE SAME 2 CASES FOR BOTH TECHNICAL AND INTERPRETIVE QUALITY

You’ve already selected your 2 abnormal cases for the physician peer review to complete your interpretive measure. You now need to review the technical quality of 2 studies per testing area per quarter. Why not review the same two studies for both your Technical and Interpretive Measures! Your physician peer review form can include options for commenting and grading the technical quality of the study. Are all clinical questions answered? Are the measurements correct? Etc. What a great opportunity to get feedback from a physician regarding the technical quality of a study! In addition, your Technical Director (or designated staff member) can also review the study to ensure the protocol was followed, etc. We have found this to be a wonderful opportunity for sonographers/technologists to receive feedback from the interpreting physicians on the technical quality of their studies.

HACK #3: DECIDE ON BEST WAY TO COMPLETE: INDIVIDUALLY OR AS A GROUP

There are many ways to complete this combined peer review to meet the technical and interpretive measures. You can assign these cases to the physicians to review on their own time or you can review them as a group at your QI Meetings.

4 Tips for Individual Peer Review

If you assigned the peer review to be completed individually by the physicians we strongly recommend some kind of regular reminder to ensure the forms are completed before the end of the quarter.

1. Provide each physician with a peer review form that allows them to comment on both their interpretive findings and the technical quality. In addition, if the Technical Director (or designated staff member) is involved in the review of technical quality they too, would receive a review form.
2. Collect all review forms
3. Review findings for discrepancies and variability
4. Report findings to all staff and discuss at QI meetings

4 Tips for Group Peer Review

This is a great option for larger labs as the peer review will be completed live at a meetings and prevents the need for the physicians to complete the peer review on their own time.

1. Make sure you have access to view images at your meeting. Pull up the 2 peer review cases at the meeting so all physicians can review the study
2. All in attendance will review the study and complete their review form
3. When the attendees complete the forms, open up the review for discussion. What pathology did they identify, severity, technical quality, etc.
4. Discuss findings and resolve discrepancies. If you have clinical correlation results you can discuss these findings to aid the discussion

We have discrepancies, now what?

You can handle discrepancies in the technical and interpretive measure in any way you see fit. Remember the goal is continual quality improvement not perfection. Anything that is looked at gets better! The one word answer that we think is the most appropriate in all situations, whether a technical issue or an interpretive issue is EDUCATE!

1. Review discrepancies and issues with all relevant staff member
2. Provide additional clinical correlation to assist with assessment of accurateness
3. Provide additional training and education.

NOT TOO SHABBY!

You now have the tips and tools to easily complete 3 of the 4 mandated QI Measures; report completeness, technical measure and interpretive measure! Take the steps to implement these ideas into your lab! Next week we will review another required QI Measure and share our timesaving hacks that allows you to achieve accreditation with quality and ease.

Remember, the Intersocietal Accreditation Commission is always happy to answer questions and they provide a wealth of resources on their website at www.intersocietal.org. In addition, our team at CardioServ is always just a phone call away. Soon,  we will release an easy to order tool box that includes all the forms you need along with weekly eTutoring to guide you through each step.

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