Quality assurance in cardio-pulmonary exercise testing

Abstract Introduction Quality assurance (QA) ensures agreed standards are being met and facilitates service improvement. Recent government initiatives aiming to increase diagnostic activity to reduce wait times emphasises the importance of a robust framework to assess standards and drive improvement. Quality frameworks exist for other areas of cardiac diagnostics but there is limited information on assessing quality in cardio-pulmonary exercise testing (CPET). Purpose We aim to develop and pilot a quality assurance framework for CPET. This will facilitate further QA development in this area and drive continuous service improvement. Methods Data were collected from June to November 2023. A random sample of 10% of tests were selected each month. A total of 39 tests were included. Our framework consisted of 30 checks across four domains: Requesting, data quality, reporting, and documentation. Checks were assessed for compliance using a Red, Amber, Green (RAG) rating system. Green - compliant. Amber - minor deviation (e.g., minor deviation from spirometry repeatability criteria). Red - significant deviation (e.g., incorrectly plotted VO2 peak). An overall test rating was then given: Green (≤ 3 amber), Amber (4 – 5 amber) and Red (> 5 amber or any red). Results The analysis comprised of individual domain checks and an overall test rating (OTR). Domain results (figure 1.) were: Requesting 95%; Data Quality; 89%, Reporting 96%; and Documentation 98%. OTRs (figure 2.) were as follows: Green (85%), Amber (13%) and Red (2%). Tests with a red OTR led to supportive discussions with operators, additional training and follow up QA. Protocol selection and spirometry repeatability were the most common individual check deviations (41% amber and 31% amber respectively). Conclusions Our QA framework showed that overall CPETs were being conducted to a high standard. There were however some variances identified which led to targeted staff training and additional audits to guide service improvement. Qualitative and subjective aspects of CPET make QA complex and a patient focused model should be employed. It is also salient to note that QA in CPET should be developed to be pragmatic and scalable to the service to ensure sustainability.Figure 1:Domain resultsFigure 2:Overall test rating