Technical Protocols: The Why, What And How

from the January 2005 issue

One of the most important goals of the accreditation process is to provide a method of standardization. In fact, the lack of standardization in vascular laboratories throughout the country was a primary reason that the ICAVL was originally founded. Though The ICAVL Standards provide guidelines for minimum testing, interpretation and quality assurance requirements, the application of consistency based upon these guides is dictated by the congruity of testing procedures performed within each laboratory. One of the simplest methods of assuring adherence to The ICAVL Standards, reproducibility of examination results, and consistent documentation is achieved through the use of technical protocols.

Technical protocols should be written for every testing procedure performed in the laboratory and ought to define the steps taken in performing and documenting a complete examination. As well, the protocol will include a brief description of the equipment and technical methods used to obtain the required documentation. When present, technical limitations and contraindications for the examination should be listed. There are companies selling prepared protocols that can be a helpful guide; however, it is imperative that these be edited to reflect the actual procedures and practices employed within the individual laboratory.

During the application review process, it is frequently noted that the technical protocols submitted are vague, lengthy and cumbersome, or outdated. Because of frequent changes in technical staff members in the vascular laboratory, well-written protocols are invaluable in avoiding confusion among sonographers regarding the laboratory's specific requirements for each testing procedure. The assurance of consistency among the technical staff members and in the documentation of examinations can also aid in more reliable and effective final interpretations that ultimately affect the quality of patient management.

For ICAVL accreditation purposes, the technical protocols should include a minimum of the documentation required by The ICAVL Standards. However, if a laboratory chooses to include documentation beyond the requirements of the Standards, these should be addressed in the protocol and reflected in the laboratory examinations (and thus the submitted case studies for review).

Because of regularly changing technology and practice standards, the protocols should be assessed and updated on a regular basis. As an example, The ICAVL Standards are reviewed by the Board of Directors and ICAVL staff every two years. A good practice for laboratories is to look at their protocols each time the new ICAVL Standards are published, making any necessary adjustments and assuring that the actual practices within the laboratory are consistent with the corresponding written protocols.

A clear, concise protocol is generally of most value to the sonographers in a laboratory. Though they should be thorough, wordy protocols lend to the loss of important information within paragraphs of text and can be frustrating to the staff they are intended to assist. A sample protocol is provided as an example of what the ICAVL looks for in the submitted technical protocols. There are various formats used in developing protocols and this is provided only as an example and not a format required by the ICAVL.

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