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Quality Review and Ongoing Certification for the first trimester scan 

How performance is measured – Standards used for assessment of performance
  1. For operators scanning a normal population and taking measurements according to the Australian Nuchal Translucency Program and the Fetal Medicine Foundation (FMF) guidelines, the overall Bias of paired NT and CRL measurements is estimated relative to the FMF reference curve and is the primary focus of audit feedback. Ideally, half the measurements should lie above the curve and half below.
  2. The NT Bias relative to the FMF reference curve should be 0.10mm or less. A deviation from this could indicate systematic under-estimation or over-estimation of the measurements. However, if an operator has scanned 30 or less patients, it is not possible to draw any meaningful conclusions from the data submitted.
  3. Please refer to this document on the NT website for further information on Bias, Spread and Trend and interpreting your audit report- https://nuchaltrans.edu.au/Documents/Audit-Assessment-Guide-(1)
Annual Audit
 
All licensed Operators are required to submit data and 1 Nuchal Translucency image for their annual audit. For Operators who are licensed to perform Nasal Bone, Uterine Artery Pulsatility Index (UAPI) and Ductus Venosus (DV) Screening, 1 image is also required to be submitted annually for audit.

The annual audit involves assessment of the distribution of NT measurements of each operator and assessment of their images. Operators passing their audit will be re-audited and re-licensed on an annual basis.
 
If operators are working at multiple centres, their image should be submitted for the first audit they participate in for each calendar year. Only one image submission is required annually, and images can be submitted from the operators preferred workplace.
  1. If the operator meets the required standard their FMF Software license will be renewed for 12 months.
  2. If the operator has not met the required standard following the annual audit the license will be renewed for 6 months.
Less than 30 scans
 
The distribution of NT measurements cannot be meaningfully assessed if fewer than 30 scans have been performed.

If an operator does not meet the minimum number of measurements in the audit cycle, then the number of scans required from up to three previous cycles will be amalgamated with the current cycle to reach the minimum 30 required.

If the amalgamated throughput is still less than 30 after combining four cycles then a red flag will be issued.

If operators are unable to secure a case load of 30 plus cases annually for 2 consecutive years the license may not be renewed for a third year subject to review.

In addition to the annual audit of practice, all operators are encouraged to perform their own internal quality assurance (audit) on a regular basis by examining their distribution of NT measurements using the automated audit module incorporated within the FMF risk calculation software.
 
NT Audit Images
 
Only 1 NT image will be required for audit from January 2020. 

Compliance
  • If an operator’s audit result generates a Red Bias and they fail their audit image assessment, they must supply one more image at their short audit in 6 months’ time. This image needs to be collected prospectively.
  • If an operator has low numbers (<30 for the year) and their audit image does not pass, they will be placed on a 6-month license and be asked to submit another image for assessment within those 6 months.  This image needs to be collected prospectively.
  • Operators who submit, but do not pass, the 6-month audit image will receive a warning to indicate that their license will be removed at the next major annual audit if they do not submit and pass their audit image.
  • Operators who do not submit a further image at 6 months will have their license removed.  
Non-compliance
  • If an operator does not submit an image for audit, they will be placed on a 6-month license and be asked to submit another image for assessment within those 6 months. This image needs to be collected prospectively. If the operator again fails to submit an image at the 6-month audit, their license will be removed.
Marker Images (NB, UAPI & DV)
  • Only 1 image for each marker an operator is certified for is required for audit from January 2020.
  • If an operator fails a marker image, they will be placed on a 6-month license and be asked to submit another image for assessment within those 6 months. This image needs to be collected prospectively. 
  • If an operator does not re-submit another marker image for assessment within the 6-month timeframe, they will receive a warning to indicate that they will be switched off for that marker in the software at the next major annual audit if they do not submit and pass an audit image for that marker.
  • Operators who submit, but do not pass, another marker image for assessment within the 6 month timeframe will receive a warning to indicate that they will be switched off for that marker in the software at the next major annual audit if they do not submit and pass an audit image for that marker. 
New license holders 
 
Operators who obtain the Certificate of Competence in measuring the NT and a license to use the FMF software will have a short audit 6 months after they first start scanning at a centre:
  1. If the operator meets the required standard their FMF Software license will be renewed to be in-line with the centre license.
  2. If the operator has not met the required standard following the ‘Short audit’ their FMF software license will be renewed for 6 months.
  3. If the subsequent audit in 6 months fails to meet standard, the license will not be renewed.
Appeals

This document is the policy and guidelines for the RANZCOG Appeals Committee (a Standing Committee of the Board), which hears appeals in relation to decisions made by or on behalf of the RANZCOG. It took effect on 27 March 2004, when it was approved by the RANZCOG Council, and includes subsequent amendments. Selecting this link will take you to the document.

Document Created December 2014

Document Reviewed April 2017
 
Document Reviewed December 2019




 

Audit Fees

How to export audit data

How to perform a self audit