title: Predictors of Delayed Accreditation of Echocardiography Laboratories: An Analysis of the Intersocietal Accreditation Commission Database.
abstract: BACKGROUND
  Intersocietal Accreditation Commission Echocardiography accreditation involves a broad-based evaluation of a given echocardiography facility's daily operation. An in-depth analysis of the most frequent noncompliant accreditation items provides learning opportunities for improvement of echocardiographic practice and facilities.
  
  
  METHODS
  Data from 3,260 facilities applying for accreditation from 2011 to 2013 were analyzed to assess five key elements, each including multiple variables. The key elements included staff qualifications, imaging protocols, image quality, reporting, and documentation of quality improvement activities. Site characteristics for each facility were also analyzed.
  
  
  RESULTS
  Sixty-two percent of facilities (n = 2,020) demonstrated deficiencies resulting in delayed accreditation. Deficiencies were less frequently observed at hospital-based facilities, facilities applying for reaccreditation, and facilities with credentialed sonographers. The most frequent deficiencies were related to reports (48%), followed by staff qualifications (46%), quality improvement (45%), image quality (44%), and protocols (43%). Both reports and image quality had the highest average numbers of deficiencies per facility, with 2.0 ± 1.0 and 1.83 ± 0.82, respectively. The most common deficient variables were lack of documented continuing medical education (25%), incomplete protocols (36%), incomplete interrogation of aortic stenosis from multiple views (34%), incomplete reports (36%), and insufficient annual summary of quality improvement activities (45%).
  
  
  CONCLUSIONS
  Accreditation is delayed for a majority of facilities seeking Intersocietal Accreditation Commission Echocardiography accreditation because of major deficiencies or noncompliance. By focusing on staff continuing medical education, adoption and implementation of standard imaging protocols, ensuring acceptable image quality, using standards in reporting, and implementing quality improvement programs, echocardiography facility performance and quality as compared with the Intersocietal Accreditation Commission Echocardiography standards may be improved.
authors.affiliation: Department of Cardiology, Methodist DeBakey Heart and Vascular Center, Houston, Texas. Electronic address: snagueh@houstonmethodist.org.
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Nagueh
authors.affiliation: Intersocietal Accreditation Commission, Ellicott City, Maryland.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Farrell
authors.affiliation: College of Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Merri L
authors.initials: ML
authors.lastname: Bremer
authors.affiliation: Centers for Behavioral and Preventive Medicine, The Miriam Hospital & Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island.
authors.forename: Shira I
authors.initials: SI
authors.lastname: Dunsiger
authors.affiliation: Intersocietal Accreditation Commission, Ellicott City, Maryland.
authors.forename: Beverly L
authors.initials: BL
authors.lastname: Gorman
authors.affiliation: Department of Medicine, Greenville Health System, Greenville, South Carolina.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Tilkemeier
mesh_terms: D000068:Accreditation / Q000706:statistics & numerical data*; D002309:Cardiology / Q000193:education*; D004452:Echocardiography / Q000592:standards*; D004502:Education, Medical, Continuing / Q000379:methods*; D019983:Guideline Adherence; D006801:Humans; D007755:Laboratories, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012955:Societies, Medical / Q000706:statistics & numerical data*
keywords: Accreditation; Echocardiography; Quality