P0145 - Quality Improvement Methodology Facilitates Adherence to Echocardiogram Protocol Measurements

Background:
Local institutional echocardiogram protocols reflect standard measurements as per the American Society of Echocardiography guidelines, but adherence to echocardiographic protocol-specific measures was inconsistent. This impacted the ability to use serial measurements for clinical decision making. We aimed to improve complete adherence to universal and protocol-specific measures for patients undergoing echocardiograms for first-time studies or cardiomyopathy to 90% from July 2019 to February 2020.

Methodology:
All sonographer performed echocardiograms for first-time studies or cardiomyopathy were included. In addition to universal measures, protocol-specific measures were obtained across all studies. The measures were converted into a scoring system reflecting whether a measurement was completed with a total of 9 points attainable for universal measures. First-time study measures could attain 7 points and cardiomyopathy protocol measures could attain 9 points. A control chart was used to measure compliance. A baseline was established over 2 months and then interventions, including sonographer education, technical improvements to the measurement tools bar, and group and individual performance feedback were incorporated via PDSA cycles over 4 months.

Discussion:
Over 2360 studies were reviewed. Reporting of complete universal measures improved significantly from a median score of 60% to 93%. Protocol-specific measures for first-time studies also showed significant improvement from 62% to 90% adherence. Cardiomyopathy-specific measures demonstrated 87% adherence at baseline, which improved to 95%. Sonographer education and adjustment to the tools bar used to report measures prompted special-cause variation with further improvement seen following individual performance feedback. The universal and protocol-specific measures reached the goal of 90% adherence with sustained improvement for over 3 months (Figures 1 and 2).

Conclusion:
Quality improvement methodology can be employed to improve complete adherence to echocardiographic protocol measurements, thereby facilitating consistency of echo quality and reporting. These interventions can be spread to improve adherence to other protocols. Further changes to the reporting system and sonographer training will be incorporated to further sustain improvement.