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The IAC Standards and
Guidelines |
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Cardiovascular Catheterization Standards |
2.1C As
part of the ongoing QI Program, facilities must incorporate the measurement of
the appropriateness of the procedure being performed based on criteria
published and/or endorsed by professional medical organization(s).1,2,3,6
2.1.1C The
facility must evaluate and document the appropriateness of the procedure
performed and categorize as:
2.1.1.1C appropriate
/ usually appropriate;
2.1.1.2C may
be appropriate; and
2.1.1.3C rarely
appropriate / usually not appropriate.
2.1.2C Appropriate
indications must be measured for a minimum of four cases per cardiovascular
catheterization accreditation procedure type (adult diagnostic catheterization,
percutaneous coronary invention [PCI], valve interventions, structural heart
interventions, complex adult congenital heart disease [ACHD], pediatric cardiovascular
catheterization) as possible be reviewed every six months.
(See Guidelines below
for further recommendations.)
2.2C The
QI Program must include an assessment of the image quality for the
cardiovascular catheterization procedures being performed and have a process
for documentation of complications with the goal to decrease complications.
2.2.1C The
facility must evaluate the technical quality of the images obtained during the
performance of cardiovascular catheterization procedures. The review must
include, but not limited to, the evaluation of:
2.2.1.1C the
clinical images for clarity of images and/or evaluation for suboptimal images
or artifact;
2.2.1.2C completeness
of the study; and
2.2.1.3C adherence
to the facility imaging acquisition protocols.
2.2.2C Technical
quality review must be measured for a minimum of four cases per cardiovascular
catheterization accreditation procedure type (adult diagnostic catheterization,
percutaneous coronary invention [PCI], valve interventions, structural heart
interventions, complex adult congenital heart disease [ACHD], pediatric cardiovascular
catheterization) as possible be reviewed every six months.
2.3C The
QI Program must include assessment of the safety of the procedures being
performed and have a process for documentation of complications with the goal
to decrease complications.
2.3.1C Areas
that must be assessed include, but not limited to:
2.3.1.1C all
procedural complications including all serious adverse events;
2.3.1.2C patient
and personnel safety must be evaluated to include, but not limited to:
i. accuracy
of patient identification;
ii. medication safety;
iii. infection control
measures; and
iv. staff
(occupational) and patient radiation exposure monitoring according to state
regulations and published guidelines where appropriate.17,20,21,22,23,45
2.3.1.3C documentation
of adverse technical events such as equipment or device failure.
2.3.2C Participation
in a national registry for all patients is strongly recommended.
2.3.3C Safety
and procedural outcomes must be measured for a minimum of four cases per
cardiovascular catheterization accreditation procedure type (adult diagnostic catheterization,
percutaneous coronary invention [PCI], valve interventions, structural heart
interventions, complex adult congenital heart disease [ACHD], pediatric cardiovascular
catheterization) and be reviewed every six months.
2.3.4C Outcomes
data, which must be consistent with national benchmarks when available, must be
used to improve processes and procedures (refer to Appendix
C).
2.4C The
facility must evaluate the quality and accuracy of the results of the
cardiovascular catheterization procedure, including any pertinent positive and
negative findings particularly those relative to the indication for exam.
2.4.1C Anonymized
peer review, or blinded review is required when only one interpreting physician
is present in the facility.
2.4.2C Interpretive
quality peer review must be measured for a minimum of four cases per
cardiovascular catheterization accreditation procedure type (adult diagnostic catheterization,
percutaneous coronary invention [PCI], valve interventions, structural heart
interventions, complex adult congenital heart disease [ACHD], pediatric cardiovascular
catheterization) and be reviewed every six months.
2.5C The
facility must evaluate the final report for completeness and timeliness as
required by Standards 1.5B through 1.9B.
2.5.1C Final
report completeness and timeliness must be measured for a minimum of four cases
per cardiovascular catheterization accreditation procedure type (adult diagnostic
catheterization, percutaneous coronary invention [PCI], valve interventions, structural
heart interventions, complex adult congenital heart disease [ACHD], pediatric cardiovascular
catheterization) and be reviewed every six months.
Comment:
Please refer to IAC Cardiovascular Catheterization Standards – Procedure
Interpretation and Reports, 1.5B through 1.12B.
2.1C There
should be a mechanism for education of referring physicians to improve the
appropriateness of testing.
A
program for documentation and reporting should be developed and include:
·
patterns of
appropriate procedures performed;
·
baseline rate of
appropriate procedures;
·
goals for improvement
in the performance of appropriate procedures; and
·
measurement of
improvement rate.
2.2C There
should be a mechanism for assessing the quality of diagnostic coronary
angiography.
A
program for diagnostic coronary angiography assessment should include quality
classification for: 47
·
coronary contrast filling;
·
coronary sinus reflux; and
·
global coronary angiogram quality.