Optimizing The Performance Of None Your Vascular Lab And Its Impact - PowerPoint PPT Presentation

4/7/2017 Disclosure Optimizing The Performance Of • None Your Vascular Lab And Its Impact On Modern Vascular Practice Warren Gasper MD Adapted from slides by: UCSF Vascular Surgery Russell H. Samson, MD, RVT, FACS Clinical Professor of Vascular Surgery Florida State University Medical School President, Mote Vascular Foundation, Inc 4/7/2017 UCSF Vascular Surgery Symposium 2017 Medical Editor, Vascular Specialist Senior Surgeon, Sarasota Vascular Specialists The winds of change are blowing hard New Opportunities - New Challenges • After many years of stability the vascular lab field faces many new challenges but also new opportunities 1

4/7/2017 New Challenges Competition from Abusive Practices • Insufficient qualified technologists • Many labs are doing them without qualified personnel to perform or • High cost of the new equipment interpret the studies • Competition from CT and MRA • Mobile facilities are going into physicians offices encouraging overuse and providing poor quality studies and oversight • Abuse and competition by untrained • Physicians with no training in these tests are establishing labs in their physicians in unrelated specialties offices and having studies interpreted by outside doctors who do not • Cuts in Reimbursement supervise the facility, tests, technologist or equipment • Local carrier rules that prevent • We have to repeat studies often for no or minimal appropriate use reimbursement New Opportunities Optimizing the lab • Improve Efficiency • Superb ultrasound technology • Improve Quality • Advanced physiologic technology • Improve Utility • Advanced reporting packages • Greater awareness of utility by referring MD’s • More utility in the OR • Insurers’ insistence that trained techs and MDs do the studies 2

4/7/2017 What Is a Vascular Laboratory Reporting Optimizing the lab Package? • Adopt a reporting package • A computerized database software program that allows: • Patient data acquisition • Hard drive data storage • Clinical report generation • Data manipulation and analysis Improves efficiency Data Analysis - Efficient Lab Administration • Patient data entered directly into the • Ongoing evaluation of lab and technologist accuracy computer. Don’t need a paper worksheet • Computer generated log books • Mouse clicking on drop down lists save time • Scheduling writing • Managed care information • Automatic calculation of values • Referral analysis ABI, IC/CCA ratio etc • Patient demographics • Diagnostic machine-to-computer data input • Computer generated conclusions • Fax reports immediately from the computer 3

4/7/2017 Data Analysis – ICA – vascular accreditation Improves Quality • Data analysis and ICAVL report generation in minutes not weeks • The Tests • Statistical evaluation • Accuracy • Sensitivity • Specificity • Positive and Negative Predictive values • Receiver Operator curves • These may change so don’t rest on you laurels! Improves Quality Improves Quality • The Technologist • The Interpreting Physician • Compare tests between techs • Time to completion • Test Duration • Tech productivity 4

4/7/2017 Improves Quality Improves Quality • The Ordering Physician • Administrative • Are tests they order appropriate to the disease process? • Timely report distribution • Appropriate requests? • Log sheet • Venous tests every other day! • Scheduling • Appropriate indications for billing purposes • Follow-up Improves Quality Impact on Clinical Practice - • The modern lab reporting packages are databases • The Patient • All data can be analyzed by field or • Compliance with follow-up group of data fields • Complaints • Example: find all men over the age of 65 who have ever smoked and have had a duplex ultrasound of the aorta 5

4/7/2017 Clinical Practice - Stroke risk Clinical Practice – Aneurysm growth patterns • Patients whose • Asymptomatic patients with aneurysms have grown carotid stenosis of >70% more than 0.5 cm in • Show rate of re-stenosis the last 6 months progression after • Average growth rate endarterectomy Clinical Practice - Graft surveillance Clinical Practice – Data Manipulation • Schedule patients for follow-up • Revise conclusions and reports based on new new diagnostic criteria • e.g. Change stenosis from 60% to 70% based on new hemodynamic criteria tests • Send out reminder notices prior to tests • Show roster of patients who have missed tests • Find patients at risk by querying velocity profiles 6

4/7/2017 Clinical Practice - Data Storage Clinical Utility • Access to clinical information • Carotid Disease • Rapid access to data from any computer anywhere • Well defined criteria for analyzing degree of stenosis • Fast • Risk free • Allows evaluation of plaque morphology that • May allow prediction of potential stroke • Essential information for new technology such as TCAR Clinical Utility Clinical Utility • Venous Disease • Arterial Physiologic studies • Duplex imaging has essentially become the gold standard • Rapid • Dominant use of the vascular lab in hospitals • Allow for longitudinal evaluation over time • Quickly establishes disease presence or normality • Pressure values help define degree of arterial insufficiency • Vein mapping • Pressure values help predict wound healing • Prior to dialysis access or bypass surgery 7

4/7/2017 An Optimized lab Optimizes Modern Vascular Clinical Utility Practice • Arterial Duplex Imaging • Somewhat time consuming • Allows for determination of possible PTA • Excellent evaluation of the Profunda femoris • Helps predict suitable site for vascular anastomosis • Can be used as an adjunct in imaging result of PTA during a procedure • Valuable adjunct for graft surveillance Optimizes Clinical Quality and Patient Care 8