ASE releases set of recommendations for quality echocardiography laboratory operations

The American Society of Echocardiography (ASE) released a set of recommendations and measurable standards for quality in the echocardiography laboratory today. The recommendations for quality echocardiography laboratory operations will be published in the January issue of the Journal of the American Society of Echocardiography (JASE).

"The objective of the report is to provide a framework for echocardiographic quality assessment and improvement, and to offer standards that are realistic goals for every practitioner," said Michael H. Picard, MD, FASE, the lead author of the document, a former president of the ASE and the Director of Echocardiography at the Massachusetts General Hospital. "Establishing a definition of quality in cardiovascular imaging has been challenging – in this document we sought to highlight recommendations for minimum quality standards with some numerical or threshold values for compliance."

The recommendations can be used as a blueprint for how to operate an echo lab at all aspects of the process – starting with considering the appropriateness of the test for the patient, culminating in incorporation of test results into patient care.

The report provides specific recommendations and standards for each of the key components of the physical laboratory and the imaging process including staff requirements, equipment requirements, patient selection, image acquisition, image interpretation and results communication. The appropriate selection of patients for echocardiography is the first essential component in the delivery of effective and cost-conscious care—avoiding over-, under- and misuse of echocardiography.

Among the important recommendations are:

• All laboratories should be accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL).
• Sonographers should achieve an appropriate national credential within the first two years of employment.
• Each laboratory should have a physician director who has completed level III training in echocardiography or a combination of level II training and current certifications from the National Board of Echocardiography.
• Details are provided as to the minimum components of each type of echocardiographic exam (transthoracic, transesophageal, stress)
• The development of a continuous quality improvement (CQI) plan, consisting of case reviews and cross modality comparisons. This includes detailed recommendations such as an annual review, for completeness and accuracy, of random samples of studies from each sonographer and physician. Guidelines are also provided to insure physician interpretations are in the medical record in a timely fashion.

To further support the importance of providing the right test for the right patient at the right time, the American Society of Echocardiography, in collaboration with the American College of Cardiology Foundation and a number of other related organizations recently released revised Appropriate Use Criteria for Echocardiography.  This document is available on the ASE Website at http://www.asecho.org/files/EchoAUC.pdf.

"A goal of the American Society of Echocardiography is that the ordering, acquisition, interpretation and communication of all echocardiograms adhere to high quality standards," said Dr. Picard. "It is our hope that following such standards will lead to continued quality improvement, patient and provider satisfaction and improved patient outcomes."