Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA.
J Am Soc Echocardiogr. 2011 Nov;24(11):1169-79. doi: 10.1016/j.echo.2011.08.018. Epub 2011 Sep 29.
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.
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.
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).
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.
本研究旨在展示在临床超声心动图实验室实施质量改进举措后，左心室（LV）舒张功能评估的特征改善。LV 舒张功能障碍的超声心动图分析是一个内在复杂的过程，需要整合多个指数进行准确评估。
回顾了 50 份随机选择的超声心动图研究的基线调查，以评估舒张功能评估的准确性。然后启动了一个四步质量改进方案：（1）对超声技师和医生进行教育；（2）使用 LV 流入、二尖瓣环早期舒张期组织多普勒速度（e'）、LV 流入传播速度（Vp）和左心房容积指数（LAVI）实施数据采集方案变更，并建立统一的诊断解释标准；（3）绩效同行审查；（4）重点互动案例审查会议。
在基线时，LV 流入的测量最准确（100%准确），而 e'（82%准确）、Vp（12%准确）和 LAVI（12%准确）的测量以及舒张功能的正确分类（44%准确）受到明显限制。在质量改进举措之后，所有记录的测量的准确性都显著提高，其中 e' 达到 92%（提高 10%；P <.10），Vp 达到 67%（提高 55%；P <.001），LAVI 达到 80%（提高 68%；P <.001），正确描述舒张功能的比例达到 76%（提高 32%；P <.001）。
包括员工教育、系统基础设施支持以及带反馈的同行审查在内的多方面质量改进方案，可有效改善非学术性超声心动图实验室在舒张功能特征描述方面的临床性能。
