The Echocardiography Quality Framework (EQF) is a unique, comprehensive, holistic approach to improving all aspects of an echocardiography service. The EQF is a patient-centered program, combining Quality Assurance and Continuous Service Improvement. The framework encompasses measures of (i) the quality of echocardiography, (ii) reproducibility and consistency, (iii) education and training, and (iv) customer feedback. The EQF is scalable and adaptable to benefit any echocardiography service. A catalogue or library of supporting documents is being developed by the British Society of Echocardiography (BSE), to be made available to any participating department. A mechanism and online infrastructure for (optional) national registration or assessment is being developed, to be used as a standalone adjunct or linked to BSE Departmental Accreditation. The principles that underpin the EQF may be applied to other imaging disciplines and, ultimately, other medical or surgical specialties.
Baskar Sekar, Richard Wheeler, Navroz Masani and Sean Gallagher
This case describes an unusual presentation of prosthetic valve endocarditis (PVE): an acute coronary syndrome. A 67-year-old male presented with cardiac sounding chest pain on a background of a short history of night sweats, weight loss and general malaise. Four months previously, he had undergone bio-prosthetic aortic valve replacement for severe aortic stenosis and single vessel bypass grafting of the obtuse marginal. Whilst having chest pain, his ECG showed infero-lateral ST depression. Early coronary angiography revealed a new right coronary artery (RCA) lesion that was not present prior to his cardiac surgery. Using multi-modality cardiac imaging, the diagnosis of PVE was made. An aortic root abscess was demonstrated that was causing external compression of the RCA.
PVE accounts for up to 20% of all cases of infective endocarditis.
High clinical suspicion and early blood cultures before empirical antibiotics are key as the presentation of PVE can often be atypical.
PVE rarely presents as an acute coronary syndrome. Potential mechanisms by which PVE may result in an ACS include coronary embolization, obstruction of coronary ostia by a large mobile vegetation and external coronary artery compression from an infective aneurysms/abscess.
Repeat cardiac surgery is often required for high-risk PVE such as those caused by staphylococcal infection or severe prosthetic dysfunction.
Hannah Bellsham-Revell and Navroz Masani
Sequential segmental analysis allows clear description of the cardiac structure in a logical fashion without assumptions and confusing nomenclature. Each segment is analysed, and then the connections described followed by any associated anomalies. For the echocardiographer there are several key features of the cardiac structures to help differentiate and accurately describe them.
Nicola Smith, Richard Steeds, Navroz Masani, Julie Sandoval, Gill Wharton, Jane Allen, John Chambers, Richard Jones, Guy Lloyd, Bushra Rana, Kevin O'Gallagher, Richard Wheeler and Vishal Sharma
Hypertrophic cardiomyopathy (HCM) is a relatively common inherited cardiac condition with a prevalence of approximately one in 500. It results in otherwise unexplained hypertrophy of the myocardium and predisposes the patient to a variety of disease-related complications including sudden cardiac death. Echocardiography is of vital importance in the diagnosis, assessment and follow-up of patients with known or suspected HCM. The British Society of Echocardiography (BSE) has previously published a minimum dataset for transthoracic echocardiography, providing the core parameters necessary when performing a standard echocardiographic study. However, for patients with known or suspected HCM, additional views and measurements are necessary. These additional views allow more subtle abnormalities to be detected or may provide important information in order to identify patients with an adverse prognosis. The aim of this Guideline is to outline the additional images and measurements that should be obtained when performing a study on a patient with known or suspected HCM.
Gill Wharton, Richard Steeds, Jane Allen, Hollie Phillips, Richard Jones, Prathap Kanagala, Guy Lloyd, Navroz Masani, Thomas Mathew, David Oxborough, Bushra Rana, Julie Sandoval, Richard Wheeler, Kevin O'Gallagher and Vishal Sharma
There have been significant advances in the field of echocardiography with the introduction of a number of new techniques into standard clinical practice. Consequently, a ‘standard’ echocardiographic examination has evolved to become a more detailed and time-consuming examination that requires a high level of expertise. This Guideline produced by the British Society of Echocardiography (BSE) Education Committee aims to provide a minimum dataset that should be obtained in a comprehensive standard echocardiogram. In addition, the layout proposes a recommended sequence in which to acquire the images. If abnormal pathology is detected, additional views and measurements should be obtained with reference to other BSE protocols when appropriate. Adherence to these recommendations will promote an increased quality of echocardiography and facilitate accurate comparison of studies performed either by different operators or at different departments.
Thomas E Ingram, Steph Baker, Jane Allen, Sarah Ritzmann, Nina Bual, Laura Duffy, Chris Ellis, Karina Bunting, Noel Black, Marcus Peck, Sandeep S Hothi, Vishal Sharma, Keith Pearce, Richard P Steeds, Navroz Masani and the British Society of Echocardiography Clinical Standards and Departmental Accreditation Committees
Quality assurance (QA) of echocardiographic studies is vital to ensure that clinicians can act on findings of high quality to deliver excellent patient care. To date, there is a paucity of published guidance on how to perform this QA. The British Society of Echocardiography (BSE) has previously produced an Echocardiography Quality Framework (EQF) to assist departments with their QA processes. This article expands on the EQF with a structured yet versatile approach on how to analyse echocardiographic departments to ensure high-quality standards are met. In addition, a process is detailed for departments that are seeking to demonstrate to external bodies adherence to a robust QA process.
The EQF consists of four domains. These include assessment of Echo Quality (including study acquisition and report generation); Reproducibility & Consistency (including analysis of individual variability when compared to the group and focused clinical audit), Education & Training (for all providers and service users) and Customer & Staff Satisfaction (of both service users and patients/their carers). Examples of what could be done in each of these areas are presented. Furthermore, evidence of participation in each domain is categorised against a red, amber or green rating: with an amber or green rating signifying that a quantifiable level of engagement in that aspect of QA has been achieved.
The proposed EQF is a powerful tool that focuses the limited time available for departmental QA on areas of practice where a change in patient experience or outcome is most likely to occur.