Impact of the COVID Pandemic on Quality Measures in a Pediatric Echocardiography Lab

Background: The risks for exposure to suspected and confirmed COVID patients during transthoracic echocardiograms (TTE) led us to endorse an abbreviated scanning protocol. We sought to determine whether this impacted the TTE quality measures that were being followed in our lab prior to the pandemic. Methods: Data were collected retrospectively for four quality measures reported quarterly in our lab: Diagnostic error rate, Appropriateness of initial outpatient TTE orders and American College of Cardiology Initial TTE Image Quality Metric (IQM) and Comprehensive Exam Metric (CEM). These measures were compared between two similar quarters in pre-COVID (2019) and COVID era (2020) for non-COVID patients. Additionally, IQM and CEM of 40 TTEs in COVID patients were compared with those of non-COVID patients. Results: The IQM and CEM scored significantly less in COVID patients compared to non-COVID patients (p<0.001 for both). Systemic and pulmonary veins, pulmonary arteries and arch were not adequately evaluated in COVID patients. In non-COVID patients, there were no significant differences in the IQM and diagnostic error rate but improvement in CEM and appropriateness of TTE orders from 2019 to 2020. There was no significant change in TTEs ordered for Rarely Appropriate indications, but the proportion of those ordered for syncope, palpitations and arrhythmias increased in 2020 compared to 2019. Conclusion: Though the diagnostic error rate did not change during the pandemic and the proportion of TTEs ordered for appropriate indications increased, the imaging quality in COVID patients was significantly compromised, especially for systemic and pulmonary veins, pulmonary arteries, and arch.

Sonographer University: A Hands-On Training Course for Adult Sonographers Performing Pediatric Echocardiography

Objective: Children with critical congenital heart disease (CHD) often present in remote areas with life-threatening illness. Although performing complete pediatric echocardiograms requires significant training, remote locations necessitate sonographers with limited pediatric experience screen for CHD. The Sonographer University (SU) was designed to improve comfort in adult sonographers scanning children and recognizing CHD. Methods: The SU consisted of lectures, multimedia case studies, roundtable discussions, pathology stations, and hands-on scanning of 20 volunteer pediatric patients with either normal or diseased hearts. Topics included an overview of critical congenital heart lesions, crucial views for each defect, and pitfalls in imaging children. Results: Forty-four participants completed the SU seminar. In pretest assessment, approximately two-thirds said they were currently required to scan children. Participants’ comfort level sonographically scanning children and recognizing CHD improved substantially. A posttest showed that the course improved participants’ skill, knowledge, and confidence with pediatric studies. Conclusion: The SU seminar helped sonographers from remote areas to develop improved recognition of CHD, confidence in pediatric scanning, and methods for obtaining assistance with imaging a critically ill child.