From the Guidelines
The most recent and highest quality guidelines for echocardiography that can serve as a foundation for quality improvement projects are the 2019 ACC/AHA/ASE key data elements and definitions for transthoracic echocardiography, which emphasize the importance of standardized measurements, appropriate use criteria, and quality control measures 1.
Key Areas for Quality Improvement
- Implementing structured reporting with standardized measurements and terminology to improve consistency and reduce variability between readers
- Integrating strain imaging into routine clinical practice, particularly global longitudinal strain, which provides prognostic information beyond ejection fraction in many cardiac conditions
- Refining point-of-care ultrasound (POCUS) protocols to improve emergency cardiac assessment workflows
- Emphasizing quality control measures including image acquisition standards, interpreter proficiency assessment, and regular laboratory accreditation reviews
Benefits of Quality Improvement Initiatives
- Enhancing diagnostic accuracy
- Reducing unnecessary testing
- Improving reporting consistency
- Ultimately improving patient outcomes
Recommendations for Implementation
- Adhere to appropriate use criteria to reduce unnecessary echo studies
- Implement standardized measurements and terminology to improve consistency and reduce variability between readers
- Integrate strain imaging into routine clinical practice to provide prognostic information beyond ejection fraction
- Regularly review and update quality control measures to ensure compliance with ACC/AHA/ASE guidelines 1.
From the Research
Newest Guidelines on Echocardiography
The newest guidelines on echocardiography that a quality improvement project can be based on include:
- The use of transthoracic echocardiography (TTE) as the primary method of assessing cardiac function 2
- The measurement of left ventricular ejection fraction (LVEF) to determine the strategy for treatment of patients and influence their prognosis 2
- The use of 3D echocardiography for volume and LVEF measurements due to its higher accuracy and reproducibility than 2D echocardiography 2
- The use of new echocardiographic techniques such as global longitudinal strain measured by speckle tracking and myocardial work to detect myocardial abnormalities earlier and with greater sensitivity 2
- The assessment of left ventricular systolic and diastolic function using indices such as ejection fraction, global longitudinal strain, and non-invasive estimation of LV filling pressures 3
Quality Improvement Project
A quality improvement project in echocardiography laboratory can be based on:
- Strategic planning with metrics and timeline for assessment and re-assessment of results 4
- Ensuring and enhancing conformity with appropriate use criteria and standardization 4
- Timely completion of exams and reports, detection of discrepancies, and continuous improvement of knowledge and skills 4
- The use of resting left ventricular elastance with volumetric transthoracic echocardiography to identify different phenotypes in heart failure with preserved ejection fraction 5
Echocardiographic Methods
Echocardiographic methods for assessing left ventricular systolic function include: