How To Make Your Case Studies Count!

This issue, in addition to clarifying the number and types of cases which are now required, will take a look at some of the common problem areas and costly mistakes which can lead to application delays.

1. Cases For Review

Aortic stenosis case. This type of study allows reviewers to accurately assess both the sonographer's ability to perform 2-D images and spectral Doppler for adequate valve interrogation as well as the abilities of the interpreting physician.

Left ventricular dysfunction case. This type of study allows reviewers to evaluate the interpreting physician's ability to recognize and report wall motion abnormalities of the left ventricle. This study should be a regional wall motion abnormality and not a global cardiomyopathy. Global cardiomyopathy studies impede the reviewer's assessment of the physician's interpretation skills.

2. Details, Details: An Application Checklist
For Technical Directors and Laboratory Staff

Before sending your application, ensure that each case study complies with the checklist below. A large percentage of applications are returned or delayed because one or more of these issues are not addressed.

a) Each testing section is on its own tape or CD, and is labeled with:

1) the patient's name,
2) the type of pathology (AS or LVDF),
3) the name of the sonographer performing the study, and
4) the name of the interpreting physician.

(Please do not send testing sections (i.e., TTE, TEE, Stress) on the same tape or CD, since each reviewer may not be reviewing all sections of your application.)

b) All cases are abnormal and represent the work of as many staff members as possible.

c) All transthoracic representative cases show all the necessary ICAEL details of the cardiac anatomy and are visualized adequately.

It is understood that technical limitations will occasionally limit the sonographer's ability to adequately define cardiac structures and visualize myocardium when performing transthoracic echocardiograms. However, the representative transthoracic cases submitted for review should demonstrate all appropriate views of above-average examination quality. This is an opportunity to demonstrate your best work. Technically limited cases should not be submitted for review.

d) All cases are submitted in duplicate. Your application will be reviewed by two (2) independent reviewers, and each will require a copy.

e) All left ventricular dysfunction (LVDF) cases are regional wall motion abnormalities and not global cardiomyopathy.

f) All cases represent the laboratory's best work. The purpose of reviewing representative cases is to evaluate the interpretative and technical quality of the laboratory as a whole. Because this aspect of the application carries a significant weight of the final decision, extreme care should be used in selecting only the laboratory's best work.

3. Case Study Sample Scenarios

The ICAEL recognizes that since staff size varies, the number of case studies required is dependent upon the number of medical and technical staff per lab. To the left is a table of the current requirements -- the types of studies and the staff representation reviewers will be looking for in your application. Also included are some scenarios for both adequate and inadequate case study representations, which might help clarify the requirements as you prepare your own application.

ADEQUATE CASE STUDY REPRESENTATION:

Example 1: A laboratory with four reading physicians and two sonographers (totaling six staff members) is required to submit six case studies. Every reading physician and every sonographer must be represented in at least one case study.

Example 2: A laboratory with nine reading physicians and six sonographers (totaling fifteen staff members) must submit eight case studies. In this scenario, every sonographer must be represented by at least one case study, and some will be represented by two studies. However, one physician will not be represented among the eight case studies. The ninth physician is the only staff member excluded from submitted case studies, but since it is impossible to represent nine physicians with eight studies, the requirement is fulfilled.

Example 3: A laboratory with 24 reading physicians and 14 sonographers (totaling 38 staff members) must submit 12 case studies. The combination of case studies must represent 12 different physicians and 12 different sonographers. No sonographer or physician can be represented more than once. As a result, 12 physicians and two sonographers will not be included among the submitted case studies.

INADEQUATE CASE STUDY REPRESENTATION:

Example 1: A laboratory with 12 reading physicians and four sonographers (totaling 16 staff members) is required to submit 10 case studies. Let us assume that the cases submitted represent ten of the 12 physicians on staff, and three of the four sonographers. Accreditation would be delayed in order to review at least 2 cases from the sonographer not represented.

Example 2: A laboratory with 17 reading physicians and 8 sonographers (totaling 25 staff members) must submit 12 case studies. Again, let us assume that those cases represent 12 different members of the medical staff. If the Technical Director is represented in six of those cases and six of the remaining sonographers are each represented by a case, only seven of the eight technical staff members would be represented. Accreditation would be delayed.

Example 3: A laboratory with 8 physicians and 2 sonographers (totaling 10 staff members) is required to submit 6 case studies. If physicians submit two cases each, while technologists submit three cases apiece, only three physicians will be represented in the case studies. To fulfill the requirement, six of the eight physicians must be represented along with both sonographers. Accreditation of this laboratory would be delayed.

In Summary

The size of your laboratory's staff determines how many cases your laboratory must submit, and those guidelines are contained in the ICAEL Application For Accreditation. Because the revised application requires fewer cases, the larger your laboratory, the less likely it is that each member will be represented. However, the cases must always include as many medical and staff members as possible, and no medical or technical staff member should be represented more than once if any other member of his or her respective department has been excluded.

Please feel free to contact the ICAEL office by phone, at 410-872-0100, or email Cassie Robbins, RDCS, FASE, Technical Manager, at robbins@intersocietal.org, if you would like to discuss any specifics related to your laboratory's application.

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