Improved efficiency and diagnostic utility of inpatient transthoracic echocardiography following implementation of a sonographer-initiated perflutren-based contrast administration protocol

BACKGROUND: Up to 20% of resting echocardiograms obtained are suboptimal leading to further downstream testing and delays in diagnosis. Contrast enhanced echocardiography is well established and endorsed for use by the American Society of Echocardiography (ASE) in clinical scenarios when 2 or more adjacent wall segments are not well visualized; however, varied institutional protocols and practices in place limit such use due to increased time and personnel needed to obtain such imaging. METHODS: The purpose of this study was to determineif sonographer administered echo contrast led to decreased time to complete inpatient echocardiography exams when compared to the current institutional policy of having a registered nurse perform administration of contrast via a case-control approach. Sonographers received a one-day training course on the techniques for contrast administration. Baseline completion times (time from 1st image to last image) were reviewed in studies from March 2015 to May 2015. Sonographers who received training began self-administration of contrast the first week of June 2015. After a familiarization period, study completion times were recorded from September 2015 to December 2015 and compared to those during the baseline phase. Sonographers were not informed that they were being monitored. Patients and the public were not involved in the design or conduct of our study. RESULTS: A total of 320 patients were included for analysis. Time spent obtaining contrast enhanced imaging was not significant between the two groups (p = 0.67). Time spent to complete each echocardiogram (time from first echocardiogram image to the last contrast enhanced echocardiogram image) was significant between the two groups (37.5 ± 10.9 min sonographer administered v 49.6 ± 12.5 min in nurse administered group, p < 0.001). CONCLUSION: Utilizing a sonographer administered echo enhancement protocol results in reduced over 12 min of time saved per study.