Chapter 11: Quality Assurance
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Quality Assurance
Chapter 11
Introduction
There are many facets of quality assurance. Quality assurance can
include everything from routine maintenance of the ultrasound
and laboratory equipment through record keeping,patient tracking,
cleaning of transducers, and making certain that the correct exams
are performed on the correct patient. Quality assurance can also
include statistical processing to compare a testing procedure against
a “gold standard” testing procedure, peer review, QA meetings, and
how to ascertain the overall accuracy of the laboratory studies. In-
tricately tied to quality assurance is the process of lab accreditation
and individual certification.
We will not go into extensive detail regarding patient tracking and
appropriate clinical testing, however we will briefly discuss the role
and importance of lab accreditation and a good quality assurance
program. In general,good practice is dictated by lab protocols. Your
lab should develop consistent,methodical protocols tominimize the
number and severity of oversights and errors. The more rigorous
the process and process controls prescribed by the protocol, the less
likely there will be major errors within your lab.
The two aspects of quality control we will discuss in greater detail
are related to statistical indices and equipment performance testing.
As you will see, both of these topics present challenges to providing
quality in day-to-day ultrasound.
1. Laboratory Accreditation
1.1 Accreditation Providers
The laboratory accreditation process is designed to recognize
laboratories that provide quality services. An accredited laboratory
requires that their interpreting physicians and practicing sonogra-
phers be adequately trained and experienced to perform and/or
interpret sonography. Currently, there are several organizations
that provide ultrasound lab accreditation including the American
College of Radiology (ACR), the American Institute of Ultrasound
in Medicine (AIUM), the Intersocietal Accreditation Commission
(IAC). (Contact information for these organizations can be found
in the online 5e Extras.)
1.2 Commitment to Quality
Most states require accreditation for Medicare reimbursement.
Beyond the financial reasons, lab accreditation demonstrates a full
commitment to quality patient care and self-assessment. The ac-
creditation process requires the lab to weigh every aspect of daily
operation and its impact on the quality of health care provided to
patients. While validating their quality assurance programs for the
accreditation process,labs often identify and correct potential prob-
lems before they occur, thereby saving time and money and reduc-
ing stress. Once a lab has gained accreditation, they must continue
their commitment to quality and self-assessment by renewing their
accreditation every few years.
The natural tendency of anyone with too many demands on their
time is to claim that there is inadequate time to develop and review
a quality assurance program. “Recent data collected by ICAVL
accredited vascular laboratories has shown that repeat carotid duplex
examination of patients referred for surgical evaluation for carotid
endarterectomy have documented clinically significant differences
in as high as 61% of the reexamined patients. It was found that the
common thread amongst these outside (unaccredited) laboratories
was the lack of a quality assurance program which would have
identified the reason for these errors and provided the laboratories
with the data necessary to adjust their criteria, or refine technical
errors that may have contributed to the erroneous results.”
Brown
OW, Bendick PJ, Bove PG, Long GW, Cornelius P, Zelenock GB.
Shanley CJ “ Reliability of Extracranial Carotid Artery Duplex
Ultrasound Scanning: Value of Laboratory Accreditation.”
Journal of Vascular Surgery 2004; 39: 366-371.
As mentioned
earlier, taking the time required to create a quality program
ultimately saves time and reduces the number of errors.
As a note, it is always good to put information into perspective.
Imagine if you were the patient, what would you prefer?
1.3 Personnel Certification
Individual certification goes hand in hand with laboratory
accreditation and is increasingly important. Lab accreditation
standards require that one or more sonographers be registered, and
most employers will hire only certified staff. Additionally several
