A Single-Institution Experience With Ruptured Aortic Aneurysms

Abstract

requirements, can be met by analyzing data already collected by the VL. After a process improvement strategy, we chose to review progress in our VL related to time to interpretation (TI), patient check-in to study completion (AWT), wait time for the first available outpatient venous duplex scan (WTAA), technologist productivity, and critical results reporting (CRR).Methods: Data from our hospital-based VL was collected from 2010 to 2016. TI was automatically collected through Vascupro (Consensus Medical), and AWT and WTAA were obtained from the electronic medical record (EMR; Epic). Technologist productivity was calculated by the formula in Fig 1 . Compliance with CRR was calculated annually per Intersocietal Accreditation Commission requirements. Appropriateness of carotid duplex scans was done by expert review of International Classification of Diseases codes.Results: The TI analysis included 91,352 studies with a mean of 3.3 hours. TI improved from 5.0 to 2.1 hours but was 4.9 hours longer on weekends (P < .001). The AWT improved from 29.8 to 27.2 minutes and was 14.9 minutes shorter on the weekends (P < .001). WTAA ranged from a mean of 1 to 2.08 days. Technologist productivity improved from 90.7% to 93.6% (Fig 2). Critical results reporting audits showed a 100% compliance rate. On expert review, the International Classification of Diseases code on carotid duplex scans in the EMR was deemed inaccurate in 17.4% of cases.Conclusions: TI and AWT improved and WTAA and CRR remained steady. Much of the data are readily available in a VL standard EMR. The "plan-do-study-act" principle of the Shewhart cycle is critical to process improvement and needed as we transition from traditional accreditation mostly based on accuracy to one demanding efficiency, productivity, accountability, and appropriateness of testing. These process improvement studies will improve patient care and institutional finances, while satisfying changing Intersocietal Accreditation Commission standards and upcoming regulatory requirements of MACRA.