Development of a National Echocardiography Quality Improvement Programme: insights into feasibility, uptake, and clinical utility

There are minimal data on methods to measure and improve quality in image interpretation when reporting cardiovascular imaging studies. We sought to identify the feasibility and clinical utility of a nationally implemented quality assurance (QA) process.

A web-based platform was developed to administer a national QA module to 27 echocardiography departments within the UK. Three QA modules were delivered from 2011. The proportion of units using the QA module increased from 14 (52.2%) in the first module to 22 (81.5%) in the third module. There was no significant change in the proportion of correct answers between the first module (88.9%) and the third module (82.8%), P = 0.3. The number of echocardiographers with at least one incorrect answer increased from 16 (21.6%) in the first module to 54 (34%) in the third module, P = 0.03. Overall, in valvular heart disease cases there were 36 (10.6%) incorrect responses where qualitative assessment of the severity of valve dysfunction was tested compared with 4 (3.6%) incorrect responses where quantitative assessment of valve dysfunction was tested, P = 0.04. In chamber quantification cases, there were 36 (6.8%) incorrect responses where qualitative assessment of chamber function was tested compared with 3 (2.1%) incorrect responses where quantitative assessment of chamber function was tested, P = 0.04.

The incorporation of national QA programme is feasible with rapid uptake. The platform allows comparison of an individual's interpretation skills against a reference standard which can be used as a method to identify inter-observer variability and as a training tool.