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The final report is a critical link between the diagnostic echocardiography examination and the clinical management of a patient. Referring physicians, many of whom are not cardiologists, are entitled to a clear, complete, accurate and timely interpretation of the examination they have requested. Because final reports are utilized outside of the echocardiography laboratory, their appearance, content and timeliness reflect the quality of the laboratory to an even greater degree than the echocardiogram itself. Their impact on patient care is paramount.

The ICAEL Standards (both the Adult Transthoracic and Pediatric Transthoracic versions, Part II, Section 4: Examination Interpretation) include explicit guidelines for the content of an examination interpretation. Despite these unambiguous requirements, non-compliance with the report standards continues to be a major reason for accreditation delay. In fact, the Board of Directors delayed over one-third of all applicants from the August 1, 2007 deadline group for issues related to report deficiencies. This amounted to approximately 55% of all laboratories from that group whose applications were delayed for at least one reason.

Delay Issues Regarding Final Reports

Report deficiencies noted in the review process range from typographical errors to significantly inaccurate interpretations. The most common causes for delay are outlined below.

INCOMPLETE REPORT TEXT

Part II, Section 4.1.D of The ICAEL Standards [Adult] contains a list of 10 basic cardiac structures and the required information to be given for each. Each of the structures must be separately and specifically commented upon; "All chambers normal" is not acceptable. It is important to ensure that reports contain each of the specific comments as detailed within the Standards. For example, the Standards require a comment on mitral valve "structure and function". Therefore a comment of "Mild mitral regurgitation" is not sufficient; however, "Structurally normal mitral valve. Mild mitral regurgitation" does comply with the Standards. Although not required, a well-designed report template that prompts the user to complete each section aids interpreting staff in avoiding errors of omission.

INCOMPLETE REPORT HEADERS

The information that must be contained in the header is shown in Section 4.1.A. Commonly omitted items are the sonographer's name or other identifier, the indication and the ordering physician's name. The name of the ordering physician is required even if that individual is the interpreting physician. The sonographer's name (or identifier) is required even if he or she is the sole sonographer in the lab.

NO MEASUREMENT TABLE

The 2D or M-Mode measurements that must be obtained in the course of the study are listed in Part II, Section 3.2.2.B as well as in Section 4.1.B. These must be shown in table format. In laboratories that do not use a reporting system that can be programmed to create an actual grid-like table, measurements may be listed clearly in a separate area. It is not acceptable to intersperse the measurements throughout the text.

NON-STANDARDIZED REPORTS

The Standards are flexible in that they allow laboratories to design their reports in any format they wish; however, all reports from a single lab (including all multiple and mobile sites) must adhere to the same physical layout. They must look alike when viewed together. A lab may choose, for example, to put the summary at the beginning rather than at the end, but each report from the same laboratory must follow the identical format. Additionally, all interpreting physicians within a laboratory must agree upon and utilize uniform diagnostic criteria.

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