title: Improvement in the assessment of diastolic function in a clinical echocardiography laboratory following implementation of a quality improvement initiative.
abstract: BACKGROUND
  The aim of this study was to demonstrate improvement in the characterization of diastolic function in the routine practice of a clinical echocardiography laboratory after the implementation of a quality improvement initiative. The echocardiographic analysis of left ventricular (LV) diastolic dysfunction is an inherently complex process involving the integration of multiple indices for accurate assessment.
  
  
  METHODS
  A baseline survey of 50 randomly chosen echocardiographic studies was reviewed for the accuracy of diastolic function assessment. A four-step quality improvement protocol was then initiated: (1) sonographer and physician education; (2) the implementation of data acquisition protocol changes using LV inflow, tissue Doppler velocity of the mitral annulus in early diastole (e'), flow propagation velocity of LV inflow (Vp), and left atrial volume index (LAVI), along with the establishment of uniform criteria for diagnostic interpretation; (3) peer review of performance; and (4) focused interactive case review sessions.
  
  
  RESULTS
  At baseline, measurements of LV inflow were most often correct (100% accurate), while measurements of e' (82% accurate), Vp (12% accurate), and LAVI (12% accurate) and the proper classification of diastolic function (44% accurate) were significantly limited. After the quality improvement initiative, there were significant increases in the accuracy of all recorded measurements, with e' 92% accurate (a 10% improvement; P < .10), Vp 67% accurate (a 55% improvement; P < .001), LAVI 80% accurate (a 68% improvement, P < .001), and proper characterization of diastolic function 76% accurate (a 32% improvement, P < .001).
  
  
  CONCLUSIONS
  A multifaceted quality improvement protocol including staff education, systematic support with enhanced infrastructure, and peer review with feedback can be effective for improving the clinical performance of a nonacademic echocardiography laboratory in the characterization of diastolic function.
authors.affiliation: Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA. tjohnson@carolinashealthcare.org
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Johnson
authors.forename: John D
authors.initials: JD
authors.lastname: Symanski
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Patel
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Rose
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D003971:Diastole / Q000502:physiology; D018619:Echocardiography, Doppler, Pulsed / Q000191:economics / Q000592:standards*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000592:standards; D007318:Inservice Training; D011237:Predictive Value of Tests; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology