Katrina M Hynes, MHA RRT RPFT Supervisor - Mayo Clinic Pulmonary Function Laboratory AARC Diagnostic Chair

Transcription

1 Katrina M Hynes, MHA RRT RPFT Supervisor - Mayo Clinic Pulmonary Function Laboratory AARC Diagnostic Chair

2 Conflict of Interest I have no real or perceived conflict of interest that relates to this presentation. Any use of brand names is not in any way meant to be an endorsement of a specific product, but to merely illustrate a point of emphasis.

3 Objectives Learning objectives for this presentation: Review the required elements of an accreditation quality assurance program Describe the reporting process for the Mayo Clinic s PFL QA program Discuss the major and minor deficiency criteria

4 PFT Laboratory Accreditation Readiness Reporting Requirements ATS-ERS QA Requirements Elements Weekly BioQC - Diffusing capacity (DLCO) Syringe DLCO Monthly BioQC - Lung volumes and spirometry Isothermic lung volumes? Linearity check Bi-annually 10 sequential patient tests

5 4.0 Volume grade 3.5 Flow grade GPA Quality control feedback started Site visits and training update Year Lung Health Study Enright: Am Rev Respir Dis 143:1215, 1991

6 PFT Laboratory Accreditation Readiness Reporting Requirements

7 PFT Laboratory Accreditation Readiness

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9 Mayo Clinic s Pulmonary Function Quality Assurance Program

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12 Biological Model Normal laboratory subjects Establish mean, SD, CV 2005 & 2017ATS/ERS Standards

13 Simple BioQC spreadsheet

14 BioQC and Mechanical Model Reporting

15 BioQC and Mechanical Model Reporting

16 Deficiency Criteria - Major Compliance Non-compliance with QA requirements No syringe DLCO > 2 months missing Bio QC data Mechanical Models Syringe DLCO VIN > 3.75L Syringe DLCO VA > 3.75L BioQC Lung volumes FRC CV > 10% TLC CV >10% Spirometry FVC CV > 10% FEV1 CV >10% DLCO DLCO CV > 10% TLC-VA > -500 mls (all) * Items in blue are for spirometry only

17 Deficiency Criteria - Minor Compliance Non-Compliance with QA requirements 1 month missing BioQC data Missing weekly DLCO data Mechanical Model Syringe linearity out of range BioQC Lung volumes FRC CV > 5% <10% TLC CV > 5% < 10% Spirometry FVC CV >3% < 10% FEV1 CV >3% < 10% SVC CV >3% <10% DLCO CV > 5% < 10% MIP/MEP Either CV > 10% * Items in blue are for spirometry only

18 Technical Recommendations TGV Pant frequency outside target recommendation (30-60) Excessive switch-in volumes ERV CV > 10 Raw/sGaw pant frequency outside recommended range (90-120) and CV > 10% TLC-VA > -250 mls or > +500mls

19 BioQC and Mechanical Model Reporting

20 BioQC and Mechanical Model Reporting

21 BioQC and Mechanical Model Reporting

22 Example Feedback Report

23 COMMUNICATION ROAD MAPS

24 Mayo Clinic s Pulmonary Function Quality Assurance Program Reporting structure - spoke and wheel concept Regional PF lab will ID a QA Officer as first point of contact for questions All data will reside and be entered into the program SharePoint at: m/_layouts/15/start.aspx#/sitepages/home.aspx Access request required

25 Mayo Clinic Rochester PF Lab Distribution Regional MCHS Clinic/Hospital Regional MCHS Clinic/Hospital Channels Local MCHS Clinic/Hospital Local MCHS Clinic/Hospital Implementation Local MCHS Clinic/Hospital Rochester Communication Review data Performance feedback Regional Submit data via SharePoint Respond to feedback Awareness of local compliance Local Submit data via SharePoint Respond to feedback

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27 Mayo Clinic s Pulmonary Function Quality Assurance Program Reporting schedule: Bi-annual Assigned reporting cycle for a site Example: MCHS in Southeast Minnesota - Cannon Falls, Lake City, Red Wing September and February

28 Mayo Clinic s PFL Quality Assurance Program Strategic Goals Unnecessary repeat testing due to lack of training, education, and undefined expectations Variability in equipment used and testing methodology Awareness of national recommendati ons and guidelines for quality outcomes Quality metrics and integrative practices for pulmonary function testing across the enterprise

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30 Metrics for Success The measurement of success will be two-fold: Compliance Target = 100% Reduction in testing variability within target CV ranges at 1 year post program implementation CV < 3 - FVC, FEV1 CV < 5 - TLC, FRC, VA, DLCO

31 Mayo Clinic s Pulmonary Function Quality Assurance Program Education and training Annual PFL QA Conference Videos/webinars NIOSH course participation for all new testing staff On-site education if warranted Accreditation readiness PFT Practice Convergence: Policies and procedures Therapist/technologist driven protocols

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33 ERS 2014

34 ATS Pulmonary Function Laboratory Accreditation American Thoracic Society Appointed an Expert Panel to discuss accreditation model.

35 PFT Laboratory Accreditation Readiness Know the required ATS-ERS QA models for each testing system. Integrate them into your PFL QA recommendations into your lab practice now!

36 Mayo Clinic s PF Lab 24 procedure rooms 45 staff pts/day

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