Written by Judith Buckland, MBA, RDCS, FASE

Echo Accreditation: 5 Tips for Easier Case Study Selection

Whether you are seeking your first echo accreditation with the Intersocietal Accreditation Commission or getting ready for your re-accreditation, selecting case studies for submission is often one of the most challenging aspects.  We know that day in, and day out, you perform quality studies within your lab.  So why is it so hard to find case studies that you feel confident will meet the accreditation standards?  We will discuss a few tips to easing the process of case study selection.

Echo Accreditation Case Study Requirements

The Intersocietal Accreditation Commission requires the submission of aortic stenosis and regional wall motion abnormalities.

Aortic Stenosis

  • Must be native valves (no replacements or repairs)
  • Must have a velocity greater than 2.0 m/s
  • Does NOT have to be severe, mild AS is okay!
  • Report needs to correctly report the findings to include:  AVA, max/mean pressure gradients and severity
  • Must include the Pedoff Probe.  For tips in using the pedoff probe see our recent pedoff blog 
    • Label image, if you cannot obtain a clear spectral window just label it as “attempted”
    • You need at least 2 different pedoff window attempts with one clear spectral window
    • We suggest attempting all three windows (apical, suprasternal and right parasternal)
  • 2D and color aortic arch views – this gets missed a lot!  Take your regular transducer and take some views of the aortic arch in the suprasternal window.  Remember to show 2D and color.

Regional Wall Motion

  • Remember these need to be segmental wall motion abnormalities NOT global
  • The wall motion abnormality needs to be ischemic in nature (not due to electrical issues LBBB, or RV pressure/volume overload)

Start Early

The Intersocietal Accreditation Commission allows you to select case studies from the previous twelve months.  Use this time wisely!  Here are 5 things to do 12 months before submitting your application.  (It’s never too late to do this!)

  • Best advice we can offer:  Review your scanning protocol!!  Remember the IAC updates their guidelines on a regular basis. Make sure your scanning protocol meets minimum requirements.
    • For example, the last update amended the recommendation for diastology echo measurements to mandated diastolic echo measurements
  • Have ALL sonographers review the scanning protocol, especially the per diems and/or those that only scan occasionally
    • Best practice is for everyone to follow the same protocol
  • Flag potential case studies – start a log of potential case studies.  Nothing fancy, just the date, MRN, sonographer name, reading physician name and type of case study
  • For labs applying for reaccreditation, remember your application needs to be submitted three months prior to expiration.  Use your expected submission date (not your expiration date), when pulling studies from the past 12 months.

Number of Required Case Studies

The number of echo accreditation case studies that need to be submitted is based on the number of active staff members.  How many sonographers scan?  How many interpreting physicians?

  • 5 or fewer staff  = 4 case studies (2 Aortic Stenosis / 2 Regional Wall Motion Abnormalities)
  • 6 – 8 staff  = 6 case studies (3 Aortic Stenosis / 3 Regional Wall Motion Abnormalities)
  • 9 – 15  staff  = 8 case studies (4 Aortic Stenosis / 4 Regional Wall Motion Abnormalities)
  • 16 – 25 staff  = 10 case studies (5 Aortic Stenosis / 5 Regional Wall Motion Abnormalities)
  • Greater than 25 staff  = 12 case studies (6 Aortic Stenosis / 6 Regional Wall Motion Abnormalities)

What about part time staff members?

We are often asked if it is necessary to include all staff members?  What about the per diem that works the random weekendS, or the doctor that barely reads?  My answer to that is ….. if you can find a study for them then go ahead and include them.  If you cannot find an aortic stenosis or regional wall motion case study for them within the last 12 months, don’t stress!  You can add them at a later time.  This is not a free pass to start deleting non-compliant staff members from your application!!  Remember, we are talking about those physicians or sonographers that have a very low presence in your lab and you are truly having difficulty finding even one pathology case study within the last 12 months!

Case Study Selection

This can be tricky in large labs.  Remember, the rule is you have to represent at least each physician once, before duplicating.  If you only have 2 doctors in your group…..this is easy!  One doctor may only submit one case study and the other may be the doctor that reads the remaining three.  The tricky part is when you have a hospital with 36 doctors and you are submitting 12 case studies that cannot duplicate interpreting physicians.  Murphy’s Law usually occurs and every beautiful aortic stenosis study is read by the same doctor!!!

  • This is why its important to keep a log of all potential case studies…..it makes selection easier when you have a nice big pool of echos to select from
  • If you know that you already have a case study from one of your doctors….let’s call him Dr. Smith….and he is scheduled to read on the day that you scan another beautiful aortic stenosis or wall motion abnormality case …simply ask Dr. Smith if it is okay to have another doctor read that one case study, for accreditation purposes.

Delayed Status is Your Friend!

As a consultant, one of the best tips to ensuring a timely submission is to remember that it is often more important to submit a less than perfect application on time, with the understanding that you may receive a delayed status, than putting off submitting your application.

  • A delayed status is not a bad thing!!
  • It is actually a great tool that can be used strategically for your advantage.
  • Remember, IAC is not a pass/fail organization.
  • They will place you in a delayed status, if you fall short on any of the accreditation requirements.
  • This means that, if for example, your aortic stenosis case study is missing pedoff or another mandated view,  instead of waiting to get a new case study – just submit!
  • This makes many of our clients’ skin crawl!  The thought of not submitting their best work, or submitting an incomplete study sounds counter-intuitive.

Don’t Wait Until Everything is Perfect!

Let’s think this through though.  If you do not have a complete AS study for example, and you want to wait for perfection, while you are waiting some of your other case studies that were selected from the previous 12 months may expire, staff may change, your expiration date may pass.  On the other hand:

  • If you submit your application, knowing it has deficiencies, the IAC will start reviewing and processing your application.
  • Because you are expecting a delayed status, you will spend the next 60- 90 days (while your application is under review) finding and obtaining the perfect study.
  • When IAC renders their final decision, they will provide you with a rectification plan.
  • Everything that was good with your application is now checked off, phew…don’t have to worry about that anymore.
  • Any deficiencies will be itemized with clear, step-by-step instructions to rectify.  If IAC needs an additional aortic stenosis case study from you, no worries, you have spent the last 60-90 days gathering the best case studies possible!

Summary

The submission of case studies is the most important driving factor for submitting an application on time.  Think about it, you can submit an application without physicians completing CMEs, missing QI measures, errors on your polices….all of which will trigger a delay, but you cannot physically submit an application without case studies.  For this reason, it is vital to ensure you track potential case studies early and work hard at ensuring you have potential case studies from each physician and sonographer.

  1. Start Early- review scanning protocol
  2. Start a log – track potential case studies
  3. Keep tabs on which doctors you have case studies from – re-assign case studies to represent all physicians
  4. Submit what you have…yes, I know you are missing pedoff, submit anyway and get the delay!
  5. Once you submit your application – use your application review time (60-90 days) wisely, by gathering additional correct and complete case studies and reports

Accreditation Help

If you need help with your accreditation there are different options available to you.  Some facilities will assign a lead person to handle the process.  The Intersocietal Accreditation has lots of valuable resources available on their website to help you through the process.  We suggest the secret tool of consistency.  Just keep plodding along.  Set a side a small amount of time on a regular basis.  Small but consistent time, is the secret to stress free accreditation!  In addition, we provide both full service consulting services and accreditation software to assist you with your accreditation.  Feel free to reach out to us for help!  Learn more here:

  • Learn about our services
  • Get a quote
  • Schedule a call
    • I am amazed that so many of our readers are unaware of just how easy it is to schedule a free consultation.  Just call to chat and talk through your hurdles.  Whatever stage of accreditation you are at, we are here to help you think through the best way to keep moving forward.

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Judith Buckland, MBA, RDCS, FASE

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