White Brian R, Ho Deborah Y, Rogers Lindsay S, Natarajan Shobha S
Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Echocardiography. 2019 Aug;36(8):1515-1523. doi: 10.1111/echo.14441. Epub 2019 Aug 5.
Echocardiography education for pediatric cardiology fellows has been a recent focus leading to the implementation of "boot camps." Less is described about continuing education through fellowship and improving image quality. We noticed practice variation in echocardiograms assessing ventricular function performed on nights and weekends. Thus, we implemented a standardized protocol and assessed its impact on imaging and reporting completeness.
We created an imaging protocol for the assessment of ventricular function in the acute setting. The protocol included demographic information, a list of images to be obtained, and the methods to quantify ventricular function. The protocol was explained to first-year fellows and distributed on an electronic quick reference card. Echocardiograms independently performed by first-year fellows during their first 4 months of on-call time were assessed pre- and postintervention using a standard rubric.
Compliance with demographic reporting was high pre- and postintervention, but significantly improved after the standardized protocol (P < 0.001). Use of the protocol increased the median number of unique images obtained per echocardiogram from 13 to 17 (out of 23 required views, P < 0.001). Particularly improved was the performance of quantitative evaluations of function, including Simpson's method for left ventricular ejection fraction (four chamber: 40% vs 67%, P < 0.001; two chamber: 33% vs 67%, P < 0.001) and tricuspid annular plane systolic excursion (45% vs 80%, P < 0.001).
The introduction of a standardized imaging protocol and its distribution to first-year fellows resulted in improvements in echocardiographic reporting completeness and increased the quality of information obtained by providing more quantitative assessments of ventricular function.
儿科心脏病学住院医师的超声心动图教育是近期的一个重点，促使了“集训营”的实施。关于通过住院医师培训进行继续教育以及提高图像质量的描述较少。我们注意到在夜间和周末进行的评估心室功能的超声心动图检查存在实践差异。因此，我们实施了一项标准化方案，并评估了其对成像和报告完整性的影响。
我们创建了一个用于急性情况下评估心室功能的成像方案。该方案包括人口统计学信息、要获取的图像列表以及量化心室功能的方法。该方案向一年级住院医师进行了解释，并分发在一张电子快速参考卡上。使用标准评分标准对一年级住院医师在其最初4个月值班期间独立进行的超声心动图检查在干预前后进行评估。
干预前后人口统计学报告的依从性都很高，但在标准化方案实施后有显著改善（P < 0.001）。该方案的使用使每张超声心动图获得的独特图像中位数从13张增加到17张（共需要23个视图，P < 0.001）。功能定量评估的表现尤其得到改善，包括左心室射血分数的辛普森方法（四腔心：40%对67%，P < 0.001；两腔心：33%对67%，P < 0.001）和三尖瓣环平面收缩期位移（45%对80%，P < 0.001）。
引入标准化成像方案并分发给一年级住院医师，提高了超声心动图报告的完整性，并通过提供更多心室功能的定量评估提高了所获信息的质量。
