Under Review: Random Site Visits Assess Quality Of ICAVL Process

by Gregory L. Moneta, MD
American Association For Vascular Surgery
Representative To The Board Of Directors

from the Spring 2002 issue

Beginning in 1999, the ICAVL instituted a random site visit mechanism to assess the quality and accuracy of the application review process. Specifically, the objective of the random site visit process is to determine whether the application review process provides a thorough evaluation of the laboratory in comparison to an on-site visit. The ICAVL places great emphasis on quality assurance when evaluating the operations of vascular laboratories, and it is our philosophy that quality assurance should extend to the ICAVL's review of applications as well.

How Random Site Visits Are Conducted

From each quarterly application deadline, two applications are randomly selected to receive a site visit by means of a random computer-generated selection. The ICAVL bears the cost of a one-day inspection of these laboratories, which is conducted by a team of two site visitors. The random site visit is completed prior to and independent of the application review. Following the random site visit, two application reviewers, who have no knowledge of the random site visit results, review the application in the traditional manner. Ultimately, the Board Of Directors receives and compares the findings and accreditation recommendation generated by the site visitors with those made by the application reviewers.

Analysis Of Data From Random Site Visit Program

Each year, a total of eight random site visits are completed. Comparisons from the eight random site visits and subsequent laboratory application reviews conducted within 2001 were recently analyzed. The decisions on the Organization sections were compared for all eight laboratories. Based on the testing areas in which the laboratories applied, decisions regarding extracranial cerebrovascular testing were analyzed for seven laboratories, for peripheral venous testing for six laboratories and peripheral arterial testing for five laboratories. None of the randomly selected laboratories had applied for accreditation in intracranial cerebrovascular or visceral vascular testing.

Of the 26 comparisons, there were six disagreements between the findings of the site visitors and the final accreditation decisions, of these six findings, five were found to be minor. One serious discrepancy was found when site visitors discovered additional screening services being provided by a laboratory that were not submitted with the accreditation application, and did not comply with the Standards.

Analysis of this data supports the validity of the current ICAVL application review process. The random site visit program will be continued to allow further collection and analysis of data on an ongoing basis. The ICAVL Board Of Directors is committed to providing continuous evaluation of the review process through random site visits to ensure that the accreditation process best serves the applicant laboratories and ultimately all patients undergoing noninvasive vascular testing.

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