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The Value of Quality Improvement Process in the Detection and Correction of Common Errors in Echocardiographic
Zaher Fanari1, Usman I Choudhry1, Vivek K Reddy1
1Division of Cardiology, Christiana Care Health System, Newark, Delaware.
Insights
Implementing a quality improvement (QI) process significantly enhanced the accuracy of echocardiographic hemodynamic measurements. This led to better correlations between non-invasive echocardiography and invasive cardiac catheterization data.
Area of Science:
- Cardiovascular imaging
- Quality improvement in healthcare
- Echocardiography
Background:
- Accurate assessment of cardiac function and hemodynamics is crucial for echocardiography.
- Quality improvement (QI) processes by the American Society of Echocardiography (ASE) and Intersocietal Commission (IAC) aim to enhance diagnostic accuracy.
Purpose of the Study:
- To evaluate the impact of a structured QI process on the accuracy of hemodynamic measurements obtained via transthoracic echocardiogram (TTE).
- To improve the correlation between TTE-derived and cardiac catheterization-derived hemodynamic parameters.
Main Methods:
- Retrospective analysis of patients undergoing TTE and cardiac catheterization within 24 hours (2011 and 2012).
- Implementation of an educational QI intervention based on ASE and IAC guidelines.
- Comparison of hemodynamic parameter correlations before and after the QI intervention.
Main Results:
- Significant improvement in correlations for left ventricular ejection fraction (LVEF), E/E', left ventricle end-diastolic pressure (LVEDP), and pulmonary artery systolic pressure (PASP) post-QI.
- Pre-QI: Poor correlation for diastolic function and PASP. Post-QI: Enhanced correlation for LVEF (R=0.88), E/E' (R=0.62), and PASP (R=0.77).
Conclusions:
- A QI process, guided by ASE and IAC recommendations, effectively identifies and rectifies quality issues in echocardiography.
- This systematic approach improves the reliability of echocardiographic hemodynamic assessments in a large academic medical center.
Background:
Accurate assessment of cardiac structures, ventricular function, and hemodynamics is essential for any echocardiographic laboratory. Quality improvement (QI) processes described by the American Society of Echocardiography (ASE) and the Intersocietal Commission (IAC) should be instrumental in reaching this goal.
Methods:
All patients undergoing transthoracic echocardiogram (TTE) followed by cardiac catheterization within 24 hours at Christiana Care Health System in 2011 and 2012 were identified, with 126 and 133 cases, respectively. Hemodynamic parameters of diastolic function and pulmonary artery systolic pressure (PASP) on TTE correlated poorly with catheterization in 2011. An educational process was developed and implemented at quarterly QI meetings based on ASE and IAC recommendations to target frequently encountered errors and provide methods for improved performance. The hemodynamic parameters were then reexamined in 2012 postintervention.
Results:
Following the QI process, there was significant improvement in the correlation between invasive and echocardiographic hemodynamic measurements in both systolic and diastolic function, and PASP. This reflected in significant better correlations between echo and cath LVEF [R = 0.88, ICC = 0.87 vs. R = 0.85, ICC = 0.85; P < 0.001], average E/E' and of left ventricle end-diastolic pressure (LVEDP) [R = 0.62 vs. R = 0.09, P = 0.006] and a better correlation for PASP [R = 0.77, ICC = 0.77 vs. R = 0.30, ICC = 0.31; P = 0.05] in 2012 compared to 2011.
Conclusion:
The QI process, as recommended by ASE and IAC, can allow for identification as well as rectification of quality issues in a large regional academic medical center hospital.
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