LAUSR

OBJECTIVES Medicare Accessibility and CHIP Reauthorization Act (MACRA) brings with it increased regulatory requirements not traditionally addressed by standard Vascular Labs accreditation which is based on accuracy. The Intersocietal Accreditation Commission's (IAC) new Quality Improvement project may satisfy an Improvement Activity (IA) of MACRA. We hypothesize that other IA in MACRA such as timeliness of test results, or patient care quality performance requirements can be met by analyzing data already being collected by vascular lab. After a process improvement strategy, we chose to review progress in our vascular lab related to time to interpretation (TI), patient check in to study completion (Study Time), wait time for first available out-patient venous duplex scan (Wait Time), technologist productivity, and critical results reporting. METHODS Data from our hospital based vascular lab was collected from 2010-2016. TI was collected through our reporting software Vascupro (Consensus Medical) and Study Timeand Wait Time were obtained from Electronic Medical Records (Epic). Technologist productivity was calculated by commercially available productivity tools, and compliance with critical results reporting was calculated quarterly per our quality assurance program. Appropriateness of carotid duplex scan testing was done by expert review of ICD codes used to request the test. RESULTS TI analysis comprised 91,352 studies with a mean of 3.3 hrs. between test completion and final interpretation. TI improved from 5.0 to 2.1hrs on weekdays, and although improved over time was 4.9 hrs. longer on weekends (P<0.001). The Study Time improved from 29.8 to 27.2 min and was 14.9 min shorter on the weekends (P<0.001). Wait Time ranged from a mean of 1 - 2.08 days. Technologist productivity improved from 90.7% to 93.6%. Critical results reporting quarterly audits showed a 100% compliance rate. On expert review, the ICD code on carotid duplex scan requests in the EMR was deemed inaccurate in 17.4% of cases. CONCLUSION TI and Study Time improved, Wait Time and critical results reporting remained steady. Much of the data is readily available in a vascular lab standard EMR. The plan-do-study-act principle (PDSA or Shewhart Cycle) is critical to process improvement and needed as we transition from traditional accreditation mostly based on test accuracy to one demanding efficiency, timeliness, patient satisfaction, productivity, accountability, and appropriateness of testing. Process improvement studies will improve patient care and satisfaction, increase efficiency and throughput, while satisfying changing IAC standards and preparing for upcoming regulatory requirements of MACRA.