Using Quality Improvement Methodology to Standardize Doppler Acquisition in a Pediatric Cardiology Echocardiography Laboratory

In echocardiography, the Doppler principle allows the measurement of tissue velocities. Using the Bernoulli equation, velocities are translated to estimated pressure differences, which dictate the timing of cardiac interventions. Our echocardiography laboratory demonstrated variability in the Doppler interrogation of heart valves, leading to difficulties in comparison over time and study accuracy. To align with previously published quality metrics in echocardiography, our laboratory used quality improvement methodology to achieve measurable improvement in Doppler acquisition. METHODS: We developed a standardized protocol for Doppler acquisition and translated it to a 20-point scoring system. We established a baseline over 4 months via random assessment of 2 first-time, normal studies per day. Interventions included standardizing the process for acquisition, education, visual tracking, and individual feedback. RESULTS: The percentage of studies with a score of 16 or higher preintervention was 17%. The median score was 13.4. In total, we analyzed 407 studies, 173 pre- and 234 postintervention. Over a 4-month intervention period, the median score improved to 18.1, with 85% of studies achieving a score of 16 or higher. Special cause variation occurred after protocol distribution, education, and feedback. CONCLUSIONS: Our initiative demonstrated significant improvement in the Doppler interrogation of cardiac structures using a measurable scoring system and a concrete goal of incorporating 20 areas of Doppler assessment in normal studies. Our next step is to spread this assessment to abnormal studies, thus developing consistency in evaluating all studies throughout the laboratory.