Virtual Site Visit Assessment Procedures

Applicant sites eligible to proceed to site visit will be provided with details on how to prepare. A mutually-convenient time will be arranged during your business hours so as many of your staff (minimum 2 required on-site) and some patients are available to speak with the Assessor(s). A 30-minute technical dress rehearsal will be arranged with the Secretary before the actual site assessment. As per the above requirements, at this time, we will confirm you are ready to proceed to the virtual site visit by observing you have the following capability: (1) good internet connection, visuals and sound for you, (2a) able to communicate with (i.e., see and hear) team members and (b) patients; (3) show us you can share your screen with charts and /or patient education materials; (4) capability to take us on a tour of your centre to show us the various aspects; and (5) we will give you a random patient registry ID# and ask you to pull their chart, show it, and verify some of their information. This will then ensure you are ready to proceed to the actual site visit. If the site visit cannot be completed, the re-attempt fee shall be charged before re-scheduling. 

Where possible, the Program Certification Secretary shall attend the site assessment with the named Assessor.

During the site visit, while maintaining patient confidentiality, you will be asked to show the Certification assessor the following aspects of your program:

1. Show chart of randomly selected patient(s), stored securely, documenting:

a. Initial assessment (e.g., history, risk; quality standard 1)

b. the risk factors of tobacco use and blood pressure (quality standard 4,5), and

c.  exercise prescription (quality standard 1)

2. Show how other components of your CR program are offered (in addition to exercise at least 1 must be offered of the following: patient education [e.g., show materials], risk factor modification [e.g., show charting of cardiac medications], behavior change counselling [e.g., show charting of diet recommendations, tobacco cessation intervention] or stress management / psychosocial [e.g., show relaxation techniques recommended to patients]) (quality standard 1)

3. Introduce us to 2 members of the team of different disciplines (can include applicant; corresponding to role descriptions provided at time of application), who will describe their clinical roles in the program (if the other person cannot be available, the site visit will need to be rescheduled upon payment of the re-attempt fee) (quality standard 2)

4.  Show the policy / procedure binder / manual for handling cardiac emergencies, and summarize to Assessor (note: staff may be queried on scenarios); Show the means on-site to summon assistance in case of emergency to start life support (latter not applicable to fully remote programs) (quality standard 3)

5. We will give you a random letter to pull a patient with a surname starting with that letter (non-registry stream) or patient registry ID# (registry stream) and ask you to pull their chart.

6.  Show a patient education session (could be 1-1, virtual and/or group), or secure consent from a patient to speak with the site Assessor about their education received (e.g., about medications, lipids, diet, psychosocial). (quality standard 10-13)

The site assessor may request additional information or documentation be provided after the virtual site visit if meeting of certain quality standards is unclear. In the case where there are some outstanding questions after the visit leading the Assessor(s) to have difficulty in making the certification recommendation, the ICCPR Program Certification committee may be consulted and/or a 2nd evaluation with a different Assessor may be arranged (no fee).

After the Site Visit:

The site assessor will complete the site visit column of the Program Certification Assessment form, and tally whether the 3 mandatory standards as well as the minimum % of standards has been met or not. Within 2 weeks of the site visit, a recommended decision to certify or not shall be communicated to the Steering Committee co-chair, and where not, what potential there might be to meet some of the standards and re-attempt.

A co-chair shall review the materials, and consult with the steering committee where warranted, before rendering a final decision. The program will be provided results for each quality standard by the Secretary via email within 4 weeks of the site visit, and informed whether they have earned ICCPR certification or not. Some commentary may or may not be provided around program quality.

Note: all registry-participating programs are invited to engage with ICRR’s user sub-committee in quality improvement activities where they are interested in addressing unmet quality standards. Contact us to be part of our “community of practice” at iccpr.icrr@gmail.com.