The pandemic saw many things go virtual — and the ACR’s efforts to ensure quality and safety within its accredited sites was no exception. “When COVID-19 hit, we knew we
would have to pivot our accreditation process to ensure the best patient care,” says Warren S. Inouye, MD, a radiation oncologist in Long Beach, Calif., and recently named chair of the College’s Radiation Oncology Practice Accreditation (ROPA) Committee.

To ensure business as usual for ACR-accredited facilities and those applying for the first time, the College has been conducting virtual site surveys via a teleconferencing format to support facilities applying for ROPA and for recognition as an ACR Diagnostic Center of Excellence^™ (DICOE).

“Unlike the diagnostic side, radiation oncology has always done in-person site surveys,” Inouye points out. “It was a big deal for us to switch to virtual, but it really has been successful — for us as surveyors and for the facilities seeking accreditation or renewal.”

“Accreditation is required by CMS for reimbursement of advanced imaging modalities,” says Jacqueline A. Bello, MD, FACR, professor of radiology at Albert Einstein College of Medicine, director of neuroradiology at Montefiore Medical Center, and vice chair of the ACR BOC. “Going the extra step to achieve DICOE status is not required by legislation, but it demonstrates a practice’s commitment to quality and patient safety.” Some in-person facility site visits will resume post-COVID-19 travel restrictions, Bello says. In the meantime, the ROPA and DICOE committees will continue to provide the value-added service of a virtual option.

DICOE Draw

To achieve DICOE status, radiology practices must demonstrate achievement of the highest levels of efficiency, safety, and quality of patient care. Shortly after the pandemic hit in March of 2020, the ACR began reaching out to prospective DICOE renewal sites to explore interest in conducting virtual site surveys. Converting site surveys from an in-person to a virtual format can be a more convenient and practical way to evaluate and recognize the outstanding diagnostic imaging and patient care that radiology teams provide.

Surveys for both accreditation and excellence start with introductions (on videoconference), followed by a department tour — including a combination of sharing screens, video clips, and presentations. After the tour, surveyors and site members video conference again for review of data and Q&A. The survey team then meets separately, after which the visit concludes with an exit interview to recap findings. The surveyors look at equipment, signage, physical accessibility, and a host of measures related to radiation and MRI safety, quality monitoring and performance
and process improvement initiatives.

“We have completed approximately 60 virtual DICOE surveys since July of 2020,” says Manjusha Pandit, MS, RTR, (M), CIIP, ACR senior accreditation specialist. “Post-COVID-19 travel restrictions, we plan to conduct on-site surveys for all new DICOE sites. We are exploring the possibility of continuing the virtual surveys for renewal cycles in the future.”

Accreditation should not be an onerous process. This should be a process that everyone is invested in, because of its true purpose — the safety of patients and the quality of what we do."

ROPA Retention

Because COVID-19 affected the ACR’s ability to conduct in-person accreditation site surveys, the College embarked on a process to conduct virtual site surveys via teleconferencing for the ROPA program — fully beta testing its first ROPA virtual survey in May of 2020. From July of 2020 through September of 2021, 164 practices have used the virtual process for ROPA — with 14 practices receiving initial accreditation and 150 applying for renewals.

To carry out the survey, the host institution initiates a third-party videoconferencing platform such as Zoom or MS Teams, Inouye says. “Our surveyors use the links provided by the facility to view pertinent data. They do not log into facility systems directly,” he says. Instead, a staff member logs in and shares and navigates their screens while the survey team observes. “There may be instances where our surveyors request keyboard and mouse control to navigate through files. However, we prefer that the assigned navigators drive the process,” Inouye says.

For the virtual site surveys, the facility should be able to replicate everything the department does. “It has been a great feeling for the accreditation-seeking sites,” Inouye says. “They take on more active participation with the surveys because they are driving the show. The control is on their side.”

Virtual Visits

“Through a virtual site visit, we were better able to connect the right people with the right modality and topic, not just whoever was available the day of the site visit,” says Vikki M. Casey, BS, CPHQ, who coordinates the Imaging Safety and Quality Program for Providence Health System in Oregon.

“We ran multiple virtual surveys for hospitals and imaging facilities in our region, and all went very smoothly,” Casey says. “I appreciated the focused participation the virtual surveys yielded. The virtual format allowed our caregivers and medical directors to participate and respond to surveyors, as schedules permitted, without impeding patient care during peak clinical hours. That’s something that might not have happened as effectively in person.”

There have been other benefits, too, she adds. In person, some of the people involved in the accreditation survey process may be silent. “Inherent in the virtual format is accountability. Our teams were well-prepared and eager for their agenda time. More importantly, the virtual format allowed team members to leave and return to the survey without feeling intrusive or interrupting the meeting. This alone was a valuable instrument to share survey learnings across our teams.“

Advantages aside, a successful outcome still depends on legwork, Casey says. “A key contribution to the success of the virtual survey began with preparing for the survey. The ACR has been fantastic in its support and guidance from step one and throughout the continuum of the accreditation process — especially for our first virtual survey.”

Are virtual site surveys the way of the future for accreditation? The process is less time-consuming in a virtual format, there is no travel involved, and sites have generally been more prepared for their surveyors’ questions. “This could continue well beyond COVID-19. Accreditation should not be an onerous process,” Bello says. “This should be a process that everyone is invested in, because of its true purpose — the safety of patients and the quality of what we do.”

Virtual surveys encourage facilities to elevate the exercise to a number-one level of importance, Bello says, because it’s voluntary — the commitment to DICOE accreditation is willingly given by the facilities, their leaders, and staff. “You clearly see their flexibility and resilience,” she says. “I think the ACR has done itself proud in terms of being able to continue these site visits virtually. It has helped these sites and their patients get through the challenges that the pandemic presents.”