Documenting Your Laboratory's Commitment To Quality Patient CARE:
Complete Accurate Reproducible Examinations [continued]

It is imperative for all laboratories, whether or not they are applying for accreditation, to institute and routinely review the quality outcomes from the lab. Often, it is during this process that laboratories find that there are inconsistencies in techniques, documentation and overall quality of exams being produced by various technical staff members. As well, it may be noted that the diagnostic criteria being used by the interpreting physicians is being applied inappropriately or needs to be adjusted in order to bring about the most effective results, due to the particular equipment used by the lab or the method by which the findings are reported.

A simple way to calculate overall accuracy can be accomplished by utilizing a correlation matrix. The categories used in the matrix must be those ranges that are written in the laboratory's diagnostic criteria. As shown in the example below (figure 4), the categories appear in both the horizontal and longitudinal axis. If the comparison exams are read differently than the duplex exam, you will correlate by where the comparison findings fall within a given category. For instance, if the carotid duplex interpretation states that there is a RICA stenosis of 50 - 79% and the angiography report states there is a RICA stenosis of 70 - 75%, both findings fall into the 50 - 79% category. In the matrix, the exact correlations fall on the horizontal plane (highlighted in figure 4), so that identifying the outliers can be easily recognized and reviewed.

Figure 4. Correlation matrix +VIEW LARGER IMAGE+

For more information regarding how to implement and track quality assurance for the vascular laboratory, please refer to the article "The Importance Of Validating Examination Results," included in the May 2006 issue of the ICAVL Newsletter. The article can be viewed on the ICAVL website here.

REPRODUCIBLE

The items previously mentioned in this article (documentation, adherence to diagnostic criteria, and quality assurance) all assist in a laboratory's ability to provide consistent, standardized care. Following are some additional provisions a laboratory can make to further assist staff members in generating reliable, uniform test findings and results.

TECHNICAL PROTOCOLS

One of the simplest methods of assuring reproducibility of examination results and consistent documentation can be achieved through the use of technical protocols. The ICAVL Standards specify that protocols must be written for every examination performed by the laboratory, and protocol requirements can be located in the Testing standards, Section 3 - Techniques and Documentation of Examination Performance. The most effective protocols are clear and concise, providing pertinent information in a format that is easy to follow and reference. Lengthy protocols often lose their effectiveness because the most important elements can be lost among cumbersome paragraphs of text. Protocols should define the steps taken in preparing for, performing and documenting a complete examination. A brief description of the equipment and technical methods utilized in obtaining the required information, as well as contraindications and technical limitations of the procedure, should be included.

Utilizing the content of the Standards when writing the laboratory's protocols will help to guarantee that the minimum requirements for accreditation are being documented. In addition, the Society for Vascular Ultrasound (SVU) has published Professional Performance Guidelines for a number of noninvasive vascular testing procedures that serve as an excellent resource when preparing your laboratory's policies and protocols. A link to these guidelines can be found on the homepage of the SVU website at www.svunet.org.

PEER REVIEW

Instituting a process of peer review in your laboratory is another way to assess the thoroughness and quality of the examinations and final reports. Regularly reviewing the exam documentation, techniques, quality and adherence to the laboratory technical protocols, as well as assessing the final reports for completeness and adherence to the diagnostic criteria, assists in providing reliable and consistent results. In addition, the process can be used to augment the laboratory's quality assurance program. More direction regarding the development of a peer review policy can be found in the article "The Importance of Validating Examination Results," included in the May 2006 issue of the ICAVL Newsletter. The article can be viewed on the ICAVL website here.

CARE

The examinations and reports produced by laboratories can greatly impact the lives of those who have been referred for diagnosis of both acute and chronic peripheral vascular diseases. Putting forth the efforts required to provide the most reliable information possible through the processes of accreditation, continuing education and the daily monitoring of the laboratory practices demonstrates a commitment to quality care that is certain to be recognized and appreciated by professional associates, insurance carriers, and the patients whose well-being is directly affected by the laboratory's care.