title: The Value of Quality Improvement Process in the Detection and Correction of Common Errors in Echocardiographic Hemodynamic Parameters in a Busy Echocardiography Laboratory.
abstract: BACKGROUND
  Accurate assessment of cardiac structures, ventricular function, and hemodynamics is essential for any echocardiographic laboratory. Quality improvement (QI) processes described by the American Society of Echocardiography (ASE) and the Intersocietal Commission (IAC) should be instrumental in reaching this goal.
  
  
  METHODS
  All patients undergoing transthoracic echocardiogram (TTE) followed by cardiac catheterization within 24 hours at Christiana Care Health System in 2011 and 2012 were identified, with 126 and 133 cases, respectively. Hemodynamic parameters of diastolic function and pulmonary artery systolic pressure (PASP) on TTE correlated poorly with catheterization in 2011. An educational process was developed and implemented at quarterly QI meetings based on ASE and IAC recommendations to target frequently encountered errors and provide methods for improved performance. The hemodynamic parameters were then reexamined in 2012 postintervention.
  
  
  RESULTS
  Following the QI process, there was significant improvement in the correlation between invasive and echocardiographic hemodynamic measurements in both systolic and diastolic function, and PASP. This reflected in significant better correlations between echo and cath LVEF [R = 0.88, ICC = 0.87 vs. R = 0.85, ICC = 0.85; P < 0.001], average E/E' and of left ventricle end-diastolic pressure (LVEDP) [R = 0.62 vs. R = 0.09, P = 0.006] and a better correlation for PASP [R = 0.77, ICC = 0.77 vs. R = 0.30, ICC = 0.31; P = 0.05] in 2012 compared to 2011.
  
  
  CONCLUSIONS
  The QI process, as recommended by ASE and IAC, can allow for identification as well as rectification of quality issues in a large regional academic medical center hospital.
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, Delaware.
authors.forename: Zaher
authors.identifier: http://orcid.org/0000-0001-6360-1450
authors.initials: Z
authors.lastname: Fanari
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, Delaware.
authors.forename: Usman I
authors.initials: UI
authors.lastname: Choudhry
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, Delaware.
authors.forename: Vivek K
authors.initials: VK
authors.lastname: Reddy
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, Delaware.
authors.forename: Chete
authors.initials: C
authors.lastname: Eze-Nliam
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, Delaware.
authors.forename: Sumaya
authors.initials: S
authors.lastname: Hammami
authors.affiliation: Value Institute, Christiana Care Health System, Newark, Delaware.
authors.forename: Paul
authors.initials: P
authors.lastname: Kolm
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, Delaware.|Value Institute, Christiana Care Health System, Newark, Delaware.
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.affiliation: Division of Cardiology, Christiana Care Health System, Newark, Delaware.
authors.forename: Erik S
authors.initials: ES
authors.lastname: Marshall
mesh_terms: D003691:Delaware; D003951:Diagnostic Errors / Q000517:prevention & control*; D004452:Echocardiography / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007089:Image Enhancement / Q000379:methods / Q000592:standards*; D007755:Laboratories, Hospital / Q000592:standards*; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Doppler echocardiography; left ventricular end-diastolic pressure; left ventricular function; pulmonary artery hypertension; quality improvement