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A patient-centred model to quality assure outputs from an echocardiography department: consensus guidance from the British Society of Echocardiography

Abstract

Background: Quality assurance (QA) of echocardiographic studies is vital to ensure that clinicians can act on findings of high quality to deliver excellent patient care. To date, there is a paucity of published guidance on how to perform this QA. The British Society of Echocardiography (BSE) has previously produced an Echocardiography Quality Framework (EQF) to assist departments with their QA processes. This article expands on the EQF with a structured yet versatile approach on how to analyse echocardiographic departments to ensure high-quality standards are met. In addition, a process is detailed for departments that are seeking to demonstrate to external bodies adherence to a robust QA process.

Methods: The EQF consists of four domains. These include assessment of Echo Quality (including study acquisition and report generation); Reproducibility & Consistency (including analysis of individual variability when compared to the group and focused clinical audit), Education & Training (for all providers and service users) and Customer & Staff Satisfaction (of both service users and patients/their carers). Examples of what could be done in each of these areas are presented. Furthermore, evidence of participation in each domain is categorised against a red, amber or green rating: with an amber or green rating signifying that a quantifiable level of engagement in that aspect of QA has been achieved.

Conclusion: The proposed EQF is a powerful tool that focuses the limited time available for departmental QA on areas of practice where a change in patient experience or outcome is most likely to occur.

References

  1. Mayo Clinic. About Mayo Clinic: Quality and Mayo Clinic. Rochester, MN, USA: Mayo Foundation for Medical Education and Research (MFMER). (available at: https://www.mayoclinic.org/about-mayo-clinic/quality)

  2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP & Jankowska EA et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Journal of Heart Failure 2016 18 891–975. (https://doi.org/10.1002/ejhf.592)

    Article  Google Scholar 

  3. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal 2018 39 119–177. (https://doi.org/10.1093/eurheartj/ehx393)

    Article  Google Scholar 

  4. Crowley AL, Yow E, Barnhart HX, Daubert MA, Bigelow R, Sullivan DC, Pencina M & Douglas PS. Critical review of current approaches for echocardiographic reproducibility and reliability assessment in clinical research. Journal of the American Society of Echocardiography 2016 29 1144–1154. (https://doi.org/10.1016/j.echo.2016.08.006)

    Article  Google Scholar 

  5. Popescu BA, Stefanidis A, Nihoyannopoulos P, Fox KF, Ray S, Cardim N, Rigo F, Badano LP, Fraser AG, Pinto F et al. Updated standards and processes for accreditation of echocardiographic laboratories from the European Association of Cardiovascular Imaging. European Heart Journal Cardiovascular Imaging 2014 15 717–727. (https://doi.org/10.1093/ehjci/jeu039)

    Article  Google Scholar 

  6. American Society of Echocardiography, Adams D, Bierig SM, Dent JM, Douglas PS, Gillam LD, Keller AM, Malenka DJ, Masoudi FA, McCulloch M et al. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. Journal of the American Society of Echocardiography 2011 24 1–10. (https://doi.org/10.1016/j.echo.2010.11.006)

    Article  Google Scholar 

  7. Masani N. The echocardiography quality framework. In Echo, the Journal of the British Society of Echocardiography, volume 96, pages 5–10. London, UK: British Society of Echocardiography, 2017. (available at: https://www.bsecho.org/media/203228/echo_96_web.pdf)

    Google Scholar 

  8. Daubert MA, Yow E, Barnhart HX, Rabineau D, Crowley AL & Douglas PS. Quality improvement implementation: improving reproducibility in the echocardiography laboratory. Journal of the American Society of Echocardiography 2015 28 959–968. (https://doi.org/10.1016/j.echo.2015.03.004)

    Article  Google Scholar 

  9. Westguard JO, Barry PL, Hunt MR & Groth T. A multi-rule Shewhart chart for quality control in clinical chemistry. Clinical Chemistry 1981 27 493–501.

    Article  Google Scholar 

  10. Gladwell M. Turnaround in the Skies: “Captain, the weather radar has helped us a lot”. In Outliers: The Story of Success. Chapter 7. London, UK: Penguin, 2009.

    Google Scholar 

  11. Mcdrury J & Alterio M. Learning through Storytelling in Higher Education. London, UK: Kogan Page Limited, 2003.

    Google Scholar 

  12. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010 376 1923–1958. (https://doi.org/10.1016/S0140-6736(10)61854-5)

    Article  Google Scholar 

  13. British Society of Echocardiography. Indications for echocardiography. London, UK: British Society of Echocardiography. (available at: https://www.bsecho.org/indications-for-echocardiography)

  14. Wharton G, Steeds R, Allen J, Phillips H, Jones R, Kanagala P, Lloyd G, Masani N, Mathew T, Oxborough D et al. A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Research and Practice 2015 2 G9–G24. (https://doi.org/10.1530/ERP-14-0079)

    Article  Google Scholar 

  15. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. Circulation 2010 121 e266–e369. (https://doi.org/10.1161/CIR.0b013e3181d4739e)

    PubMed  Google Scholar 

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Correspondence to Thomas E. Ingram PhD FRCP.

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V Sharma is Co-Editor-in-Chief of Echo Research and Practice, and K Pearce and R Steeds are Strategic Editors. They were not involved in the review or editorial process for this paper, on which they are listed as authors.

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Ingram, T.E., Baker, S., Allen, J. et al. A patient-centred model to quality assure outputs from an echocardiography department: consensus guidance from the British Society of Echocardiography. Echo Res Pract 5, G25–G33 (2018). https://doi.org/10.1530/ERP-18-0053

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