Feasibility of sonographer-administered echocontrast in a large-volume tertiary-care echocardiography laboratory

Contrast echocardiography has been shown to improve diagnostic quality, especially in technically difficult patients. However, the learning curve and increased time for preparation and image acquisition have led to low use.

We sought to determine whether the contrast echocardiography procedure performed independently by a specialized, trained sonographer could improve efficiency. In our centre, routine echocardiograms were scheduled for 1 hour, and any study exceeding 1 hour would result in patient booking cancellations. We compared the standard of care, in which a physician or nurse administers echocontrast, with a sonographer-administered program (SAP).

The time to complete contrast echocardiograms was significantly reduced by the SAP strategy (43 min 17 s ± 23 min 42 s vs 1 h 1 min 6 s ± 31 min 0 s, P < 0.001). Subgroup analysis of the inpatients and outpatients demonstrated similar results. Only 10% of studies (6 of 61) in the SAP exceeded 60 minutes, compared with 45% (34 of 76) in the standard-of-care group (P < 0.001). Based on study volumes in our centre, the net improvement in productivity with the SAP could be up to 5.3% annually.

Sonographer-administered echocontrast is feasible and potentially removes a barrier to implementation of contrast echocardiography.