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

4/7/2017 1

Optimizing The Performance Of Your Vascular Lab And Its Impact On Modern Vascular Practice

Adapted from slides by: Russell H. Samson, MD, RVT, FACS Clinical Professor of Vascular Surgery Florida State University Medical School President, Mote Vascular Foundation, Inc Medical Editor, Vascular Specialist Senior Surgeon, Sarasota Vascular Specialists

Warren Gasper MD UCSF Vascular Surgery

4/7/2017 UCSF Vascular Surgery Symposium 2017

Disclosure

• None

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

• pportunities

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New Challenges

• Insufficient qualified technologists
• High cost of the new equipment
• Competition from CT and MRA
• Abuse and competition by untrained

physicians in unrelated specialties

• Cuts in Reimbursement
• Local carrier rules that prevent

appropriate use

Competition from Abusive Practices

• Many labs are doing them without qualified personnel to perform or

interpret the studies

• Mobile facilities are going into physicians offices encouraging overuse

and providing poor quality studies and oversight

• Physicians with no training in these tests are establishing labs in their
• ffices and having studies interpreted by outside doctors who do not

supervise the facility, tests, technologist or equipment

• We have to repeat studies often for no or minimal

reimbursement

New Opportunities

• Superb ultrasound technology
• Advanced physiologic technology
• 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

Optimizing the lab

• Improve Efficiency
• Improve Quality
• Improve Utility

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Optimizing the lab

• Adopt a reporting package

What Is a Vascular Laboratory 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

• Patient data entered directly into the
• computer. Don’t need a paper worksheet
• Mouse clicking on drop down lists save time

writing

• Automatic calculation of values

ABI, IC/CCA ratio etc

• Diagnostic machine-to-computer data input
• Computer generated conclusions
• Fax reports immediately from the computer

Data Analysis - Efficient Lab Administration

• Ongoing evaluation of lab and technologist accuracy
• Computer generated log books
• Scheduling
• Managed care information
• Referral analysis
• Patient demographics

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Data Analysis – ICA – vascular accreditation

• Data analysis and ICAVL report generation in minutes not weeks

Improves Quality

• 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

• The Technologist
• Compare tests between techs
• Test Duration
• Tech productivity

Improves Quality

• The Interpreting Physician
• Time to completion

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Improves Quality

• The Ordering Physician
• Are tests they order appropriate to the disease process?
• Appropriate requests?
• Venous tests every other day!
• Appropriate indications for billing purposes

Improves Quality

• Administrative
• Timely report distribution
• Log sheet
• Scheduling
• Follow-up

Improves Quality

• The Patient
• Compliance with follow-up
• Complaints

Impact on Clinical Practice -

• The modern lab reporting packages are

databases

• All data can be analyzed by field or

group of data fields

• Example: find all men over the age of 65

who have ever smoked and have had a duplex ultrasound of the aorta

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Clinical Practice – Aneurysm growth patterns

• Patients whose

aneurysms have grown more than 0.5 cm in the last 6 months

• Average growth rate

Clinical Practice - Stroke risk

• Asymptomatic patients with

carotid stenosis of >70%

• Show rate of re-stenosis

progression after endarterectomy

Clinical Practice - Graft surveillance

• Schedule patients for follow-up

tests

• Send out reminder notices prior to

tests

• Show roster of patients who have

missed tests

• Find patients at risk by querying

velocity profiles

Clinical Practice – Data Manipulation

• Revise conclusions and reports based on new new diagnostic criteria
• e.g. Change stenosis from 60% to 70% based on new hemodynamic criteria

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Clinical Practice - Data Storage

• Access to clinical information
• Rapid access to data from any computer anywhere

Clinical Utility

• Carotid Disease
• 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

• Venous Disease
• Duplex imaging has essentially become the gold standard
• Dominant use of the vascular lab in hospitals
• Vein mapping
• Prior to dialysis access or bypass surgery

Clinical Utility

• Arterial Physiologic studies
• Rapid
• Allow for longitudinal evaluation over time
• Quickly establishes disease presence or normality
• Pressure values help define degree of arterial insufficiency
• Pressure values help predict wound healing

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Clinical Utility

• 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

An Optimized lab Optimizes Modern Vascular Practice Optimizes Clinical Quality and Patient Care