A standardized imaging protocol improves quality and reduces practice variability in echocardiographic assessment of ventricular function by first‐year pediatric cardiology fellows

Abstract

Background Echocardiography education for pediatric cardiology fellows has been a recent focus leading to the implementation of “boot camps.” Less is described about continuing education through fellowship and improving image quality. We noticed practice variation in echocardiograms assessing ventricular function performed on nights and weekends. Thus, we implemented a standardized protocol and assessed its impact on imaging and reporting completeness. Methods We created an imaging protocol for the assessment of ventricular function in the acute setting. The protocol included demographic information, a list of images to be obtained, and the methods to quantify ventricular function. The protocol was explained to first‐year fellows and distributed on an electronic quick reference card. Echocardiograms independently performed by first‐year fellows during their first 4 months of on‐call time were assessed pre‐ and postintervention using a standard rubric. Results Compliance with demographic reporting was high pre‐ and postintervention, but significantly improved after the standardized protocol (P < 0.001). Use of the protocol increased the median number of unique images obtained per echocardiogram from 13 to 17 (out of 23 required views, P < 0.001). Particularly improved was the performance of quantitative evaluations of function, including Simpson's method for left ventricular ejection fraction (four chamber: 40% vs 67%, P < 0.001; two chamber: 33% vs 67%, P < 0.001) and tricuspid annular plane systolic excursion (45% vs 80%, P < 0.001). Conclusions The introduction of a standardized imaging protocol and its distribution to first‐year fellows resulted in improvements in echocardiographic reporting completeness and increased the quality of information obtained by providing more quantitative assessments of ventricular function.

Sustained improvement in fellows’ echocardiographic completeness through the coronavirus pandemic with a standardised imaging protocol

“…There was a statistically significant increase in both demographic and imaging completeness scores after the creation of the protocol (Fig 1). These results were similar in magnitude to those in the previously published analysis 8 (the demographic reporting score increased from a median of 6 [interquartile range: 5-7] to 7 [interquartile range: 6-7], p < 0.001, and the imaging completeness score increased from a median of 13 [interquartile range: 9-17] to 16 [interquartile range: 13-18], p < 0.001).…”

“…These sessions were primarily focused on obtaining the basic views and measurements necessary to perform the acute function check protocol. 8 Additional time during orientation was spent on didactic lectures, which included topics such as segmental anatomy, standard echocardiographic views, and image optimisation.…”

“…Our standardised protocol for assessing ventricular function in the acute setting has been previously described. 8 Briefly, the protocol included two sections: key demographic information to be included in the header of the echocardiogram's report; and the images to be obtained and the standard calculations of systolic function to be performed. Demographic information included the patient's height, weight, blood pressure, original cardiac diagnosis, any prior surgeries or procedures, the immediate clinical concern prompting the need for the study during off-hours (proper indication for the study), and the ordering cardiologist.…”

“…We have previously reported how the implementation of this protocol improved completeness of fellow-performed echocardiograms. 8 In 2020, due to institution-wide COVID-19 safety precautions, our orientation changed to online lectures with in-person sessions using echocardiography simulators instead of with healthy volunteers. The goal of competency with the function check protocol by the end of orientation was unchanged.…”

Quality Improvement in a Pediatric Echocardiography Laboratory: A Collaborative Process

“…Over the last decade, as the importance of QI work is increasingly recognized, there have been some relevant research efforts within pediatric echocardiography laboratories. Some QI efforts have focused on the utility of adherence to guidelines and imaging protocols [ 7 , 8 , 9 , 10 ]. Other pediatric cardiology QI efforts focus on the appropriate use of pediatric echocardiography in the clinical setting [ 11 , 12 , 13 , 14 , 15 ].…”