Critique Letter: Purpose And Use

from the Fall 1999 issue

When laboratories successfully achieve accreditation, they will receive two letters from the ICAVL. The first letter arrives within weeks of the decision, announcing that accreditation has been granted and commending the staff for their commitment to providing quality care. Enclosed with the letter is an Accreditation Portfolio containing a camera-ready logo, press release, media list and the certificates of accreditation. A second letter, the critique letter, is sent a few months after the original notification letter. Composed of comments made by the ICAVL's application reviewers, the critique letter provides guidelines and recommendations for achieving reaccreditation and, more importantly, for achieving the goal of providing top-quality diagnostic evaluations.

"The critique letter serves as a formal record of the quality of service provided by a laboratory at the time of accreditation and is one of the most important benefits of ICAVL accreditation," explains the previous Technical Manager Gail Sandager, RN, RVT. "Sometimes laboratory staff members think that the ICAVL is telling them what they do wrong, but successfully acquiring accreditation recognizes that they do the most important things right."

The critique letter is designed to serve as a tool to address issues raised during the review process. By providing the findings and comments of the application reviewers and Board Of Directors, the ICAVL anticipates that accredited laboratories will continue to explore methods of improving the quality of care provided. "Really, we would be short-changing the laboratory and the public if we just awarded accreditation and provided no feedback. Our responsibility to laboratories is that we pay attention to detail and provide a high-quality review of the application," Sandager said. "It also provides us with a means to assess the growth of the laboratory at the time of reaccreditation." When laboratories apply for reaccreditation in three years, staff members must demonstrate that they have addressed the issues raised in the critique letter.

HOW THE CRITIQUE LETTER IS CREATED

The creation of the critique letter begins with the application reviewers. Each application is reviewed by two reviewers who work independently of one another. Along with each application, reviewers receive an abbreviated version of the Essentials and Standards which focuses on particular sections within the application. As the reviewers assess each laboratory's application, they use the abbreviated version to note deficiencies and to make positive comments. They return the reviewed application and their recommendations to the ICAVL where the Technical Manager collates the data from both reviewers. Any discrepancies between the comments are individually investigated by pulling the original application and reviewing the specific item. Sometimes, discrepancies between reviewer comments are the result of missing documents between the original application and the photocopy, both provided by the laboratory. Therefore, it is recommended that a laboratory staff member carefully verify that all items were photocopied and included in both copies before submitting the application to the ICAVL.

The Technical Manager also checks the reviewers' recommendations to substantiate relevance to the Essentials and Standards. Some issues will need to be addressed immediately in order for the laboratory to achieve accreditation. These issues often result in decisions to delay or site visit a laboratory. Other issues can be corrected at a later time, and it is these comments that laboratories receive in the critique letter after a final decision is made. The collected information is then used to construct the critique letters for accredited laboratories.

CONTENT OF THE CRITIQUE LETTER

There are three important things that laboratory staff should know when reading their own critique letter.

1. Critique letters contain comments that provide a general overview of the application and do not necessarily address specific cases. The critique letter is designed to deal with issues regarding the medical and technical staff and the conduct and performance of examinations; however, the letter often addresses general findings rather than specific occurrences in the application. For example, a laboratory may receive a number of comments relating to documentation issues. While the laboratory may perform quality examinations, they did not submit enough documentation to demonstrate the level of quality required by the Essentials and Standards. In Figure 1: Sample Critique Letter on page seven of the Newsletter, items one and two are examples of comments providing a general overview of the ICAVL's observations.

2. Critique letters contain recommendations for providing improved diagnostic testing. Recommendations often include specific suggestions for laboratory improvement not currently required in the Essentials and Standards, recognizing that many laboratories may not have the resources or capability to make changes immediately. The ICAVL anticipates that laboratory staff will discuss the critique letter recommendations during laboratory meetings and make earnest efforts to implement positive change. The third item in the sample critique letter is an example of a recommendation by the ICAVL.

3. Critique letters contain requirements that must be documented to achieve reaccreditation. Because accreditation is an inclusive process, the ICAVL occasionally grants accreditation based on somewhat limited documentation with the expectation that those procedures will be better documented in the application for reaccreditation. Failure to address these issues will result in reaccreditation being delayed. Item four in the sample critique letter is an example of a comment relating to a requirement for reaccreditation.

All issues raised in the critique letter, whether recommendations or requirements, must be addressed and documented by laboratory staff before reaccreditation, particularly when comments concern technical or reporting components of the examination. Technical and reporting components are weighted most heavily during the review process. Documentation of these issues should be demonstrated in the minutes of staff meetings, in the protocols and quality assurance procedures and in the case studies submitted with the application.

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