Performance of Comprehensive Transesophageal Echocardiography: Quality Improvement Through Educational Intervention

Chen, Tiffany; Carlson, Selma; Cheney, Amy; Zwink, Todd; Freeman, Rosario V.; Kirkpatrick, James N.

doi:10.1016/j.echo.2019.03.019

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…This quality improvement intervention (which, in addition to standardized protocols, also included an increase in the use of sedation) led to an increase in image quality. Interestingly, two studies of the introduction of a standardized imaging protocol for adult transesophageal echocardiograms have shown opposing results . In Graham et al , TEEs being performed by anesthesiologists did not show any change in the number of views acquired.…”

Section: Resultsmentioning

confidence: 99%

“…In Graham et al , TEEs being performed by anesthesiologists did not show any change in the number of views acquired. Conversely, Chen et al, also developed a TEE grading system and provided ongoing feedback by e‐mail, which improved compliance by cardiology attendings. While prior studies have focused on imaging by experienced attendings and sonographers, our results show that a standardized protocol can serve as a roadmap for early learners who must perform studies in unsupervised environments without the knowledge necessary to prioritize image acquisition.…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, two studies of the introduction of a standardized imaging protocol for adult transesophageal echocardiograms have shown opposing results. 16,17 In Graham et al, 16 TEEs being performed by anesthesiologists did not show any change in the number of views acquired. Conversely, Chen et al, 17 also developed a TEE grading system and provided ongoing feedback by e-mail, which improved compliance by cardiology attendings.…”

Section: Con Clus Ionmentioning

confidence: 89%

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

White

Rogers

et al. 2019

Echocardiography

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%