Vascular Ultrasound: The Big Picture

Transcription

1 Vascular Ultrasound: The Big Picture Anne M. Jones BSN RVT RDMS FSVU Clinical Instructor in Neurology/Neurosciences Medical University of South Carolina-MUSC What is Vascular Ultrasound? The definition is highly variable Influenced by clinical setting Often divided into the anatomic area being evaluated rather than the entire vascular system Accreditation & certification are addressing the evolution of focused subspecialties within the larger specialty of vascular technology Terminology defined: Vascular Ultrasound procedures are used to evaluate the entire vascular system (excluding the heart) and diagnose abnormalities in blood flow or vessel anatomy Combined with other physiologic testing procedures, the specialty is identified as vascular technology The Scope of Vascular Ultrasound This noninvasive technology can identify arterial narrowing, venous and arterial thrombosis or occlusion, aneurysms, vascular injuries Highly operator dependent, requiring education and skill to accurately acquire data used in patient management. Studies should be performed by credentialed vascular technologists (Registered Vascular Technologists) or sonographers (Registered Diagnostic Medical Sonographers) in a laboratory that has been accredited (ICAVL/ACR) A little historical perspective D. Eugene Strandness, MD Clinical Research Diabetic Vascular Dx. Deep Vein Thrombosis Carotid Artery Disease Recurrent Carotid Stenosis Renal Artery Disease Vein Graft Surveillance 15 books, 176 book chapters, 451 journal articles Designing a Vascular Profession 1965-Strain gauge plethysmography 1967-Continuous Wave Doppler 1974-Duplex Imaging 1977-SNIVT Founding Member 1980-Color flow/power Doppler 1983-ARDMS Exam Development-RVT credential 1985-ACAS Clinical Trial 1992 ICAVL Founding Member D Ultrasound Research The Conscience of a Profession 1

2 The Basis of Vascular Technology Understand Pathophysiology of disease processes being evaluated Be able to conduct a limited physical exam, patient history & blood pressures Apply principles of flow dynamics, understanding of arterial and venous anatomy, engineering, physical principles of ultrasound and exam protocols to answer specific questions: formulate a technical impression Combining technology and research Driven by a need for education & research, a profession emerges 1977: Society for Non-invasive Vascular Technology (SNIVT) Comprised largely of registered nurses, medical students performing research, engineers developing technology, physicians in need of data about hemodynamics Most testing was physiologic Ultrasound imaging emerged in 1980 s Increased Utilization: Change SNIVT becomes SVT, then SVU Dominance of Ultrasound changes clinical utilization of technology The need for education, standards, certification, accreditation grows Inappropriate utilization by some results in federal laboratory standards (IDTF s) and reimbursement challenges The Vascular Technology Community Responds: Standards, exams, education PV Doppler exam offered by ARDMS evolves into broader vascular technology exam-1983 with strong input from SVU/SVS Cardiovascular technology educational programs include vascular technology (JRC-CVT) Vascular laboratory accreditation first voluntary process to evaluate, standardize facilities providing vascular testing Reimbursement by Medicare becomes focus 2

3 Purpose of Certification Process: Ensure competency of qualified practitioners Promote highest standards of profession Improve quality of patient care Identify those not qualified to practice Are we really taking these seriously? Did Vascular Technology Get it Wrong: In some ways, yes- Followed the path of ultrasound The technology emerged Standards were needed Exams were developed Educational programs emerged Slow, deliberate process to restart the process, develop educational programs, then require certification based on education/clinical ARDMS Cumulative RVT Data , , #RVT's Current ARDMS RVT Data Through All RVT RDMS/RVT RVT Only RDCS/RVT MD RVT Other pathways to Ultrasound Certification: Specialty focused American Registry of Radiologic Technology Ultrasound providers in primarily radiology settings Cardiovascular Credentialing International Vascular technology, cardiovascular technology both invasive and non-invasive CCI Registered Vascular Specialist: RVS Cardiovascular Credentialing International Requires Passing (or receiving exemption from) the Cardiovascular Science Examination and Passing the Non-Invasive Vascular Registry Examination Designed for Professionals working in the area of Vascular Technology (Vascular Ultrasound) 3

4 ARRT Ultrasound Examination: American Registry of Radiologic Technologists Candidates for ultrasound certification initially required to hold Radiologic Technologist (RT-R) certificate After NEC guidelines for general sonography were published, ARRT completed a pilot exam for graduates of non-rt educational programs in general ultrasound Sonography Suite: Exams in General, Breast and Vascular Ultrasound now offered ARRT Vascular Sonography Exam Available to candidates previously registered in radiography, nuclear medicine, radiation therapy, general sonography (ARDMS,ARRT) Content includes: physics and instrumentation, image production and evaluation, vascular sonographic procedures including abdominal/pelvic, arterial & venous peripheral vasculature, extracranial cerebral vasculature Appropriate credential for ICAVL Accreditation Why should Certification be Required? Best assurance of minimal competence Best available standardized method of assessing educational programs, knowledge of disease, competence with instrumentation Assures patients, physicians, employers and payers that the provider of ultrasound services has met the professional standard Quality saves money, decreases overutilization Why is certification important? Enhances practitioner standards & raises professionalism Defines profession Self-regulates the profession Increases visibility Receives recognition from other professions * Why don t practicing vascular technologists become certified? Scared- fearful of failure Not required for reimbursement Too busy, no financial incentive Not required by workplace Do not meet prerequisites Can t afford to prepare/sit for exam No one is forcing them to do it Certification may become mandatory: federal & state laws, payment policy The voluntary credential has worked well as a gold standard and model in some areas The success of voluntary programs is largely due to the commitment of the professions Current credentials may be recognized by federal and state law-more to follow Local peer pressure and multi-specialty providers emphasize need for quality and accuracy 4

5 Professional Societies: SDMS Public awareness and professional guidelines point to need for quality 86% are Active Members-must hold at least one credential to be a full member Non-credentialed are Technicians Student members not included 20,000+ members Society for Diagnostic Medical Sonography, Plano TX Even before we are all certified: Recertification is fast approaching Certification bodies must maintain their mission to promote quality care and patient safety through the certification and continuing competency of ultrasound professionals Certification Bodies must be accredited: recertification required to meet recommendations of the ISO-ANSI and NCCA (their accrediting organizations) Must reflect the present day entry-level practice of Sonography Co-exist with Continuing Medical Education (CME) programs. What about Vascular Facility Accreditation? ACR: Requires All Sonographers AIUM: Requires All*by 1 st re-accreditation ICAVL: Requires Technical Director* Recent change in Standards: ALL Technical Staff must hold Credential in each clinical specialty by January 1, 2017 *15% TD not credentialed; given 1 yr. provisional accreditation ICAVL Technical Staff Data: 92% Certified TD; 53% Certified TS Tech Dir Cert TD Tot TS Cert TS Technical Director Technical Director Certified Technical Staff Total Technical Staff Certified Vascular Technology Education National Educational Curriculum recently developed with input & support from all specialties Attempt to develop and uphold educational standards (discourage inadequate programs) Commission on Accreditation of Allied Health Education Programs (CAAHEP) oversees activities of specialty programs 5

6 Vascular Technology: Finding a program Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT*) Joint Review Committee on Education in Diagnostic Medical Sonography (JRC-DMS*) SVU and SDMS Guidelines for Undergraduate Educational Programs in Vascular Ultrasound/Sonography available on websites *Includes Vascular Technology representatives Why attend an Accredited Program? Carefully planned curriculum provides broad range of vascular technology education Clinical rotations are carefully chosen and managed to prepare students for real world Programs are designed to address specific needs of students who will be immediately eligible for certification examinations Standardized curriculum meets needs of students and assures employers of minimum competency Vascular Technology Accredited Educational programs and certification Crucial to recognition as a unique specialtynot a subset of Cardiovascular Technology or Diagnostic Medical Sonography Currently recognized as a career path by the Department of Labor- in Occupational Outlook Handbook Must achieve greater professional recognition through education to become a distinct specialty- ongoing effort by SVU Do we want to be a profession or a work force? Hire RVT s or individuals who have met educational prerequisites; require credential once prerequisites are met Provide educational support, reward achievements Experienced, qualified RVT s will be more efficient, accurate in times of decreased reimbursement Work smarter, not harder If the profession requires credentials, it must support the process: Alliance: Regulations Brick/Mortar & Web based education SVU Student Scholarships Mentors Clinical Sites for students and exam candidates Participation in development of JRC educational standards and accreditation Require credentials for membership, accreditation, jobs, research, education 6

7 In Summary: Role of Advanced Practice or Ultrasound Practitioner Is there a role? How will they be educated? Where will they fit into the healthcare system? How will physicians, hospitals react? SVU Perspective on Advanced Practice in Vascular Technology Many believe we are already practicing at this level every day Role needs to be clearly defined Educational route-natural progression? Assess clinical and practice needs Discuss legal implications Do we need Advanced Practice? On the job training being phased out BS Programs growing Distance Education Clinical Sites Require RVT for all practicing vascular technologists Funding for development, boards Seek input and guidance-vascular surgery Educational Requirements: Proposed by SDMS BS Prerequisite Well defined Master s Level Core curriculum Beyond US - global medical education Specialty specific curriculum and clinical experience National Board Certification Define Medical/legal implications Potential Concerns: Antagonism from practicing sonographers without access to UP Resistance from physicians, concern over financial implications Resistance from referring physicians Concern over increased liability/costs Concerns over ultrasound reimbursement Why UP or Advanced Practice? Increased need for ultrasound related healthcare in the United States Increased global marketplace Need for more economic healthcare Decreased # of physicians, especially rural Less costly and increasingly accurate alternative to other imaging services 7

8 Educational Pathways: Models of non-physician medical practice include Nurse Practitioner and Physician s Assistant Both have unique features whose scope of practice vary from state to state PA model requires supervising MD NP model has defined boundaries with functional autonomy UP: competency based autonomy, combining components of NP and PA Educational Pathways: Models of non-physician medical practice include Nurse Practitioner and Physician s Assistant Both have unique features whose scope of practice vary from state to state PA model requires supervising MD NP model has defined boundaries with functional autonomy UP: competency based autonomy, combining components of NP and PA Let s get all of the currently practicing sonographers certified and educated A Constant Reminder. Then focus on the next level of education and clinical responsibilities Vascular Ultrasound Big Picture It really is more than vascular ultrasound A specialty with significant impact A credential that carries distinct merit An introduction to the profession s origins- the next step is to explore the present challenges facing the profession