Like every field of endeavour, echocardiography, or cardiovascular ultrasound, faces challenges from within and without, and the response to today’s challenges will determine the future. Echocardiography confronts rapid changes in technology, financial structures, day-to-day operations, scope of practice and its workforce. Externally, the tremendous upheavals in cardiovascular medicine and in the overall medical environment are creating great pressure to change and, at the same time, provide tremendous opportunity for growth and leadership.
One of the greatest mandates for all aspects of healthcare in 2003 is the unceasing pursuit of quality. As healthcare providers first and foremost, echocardiographers know that quality impacts everything they do, every day. Their challenge as practitioners, and the American Society of Echocardiography’s (ASE’s) challenge as a professional society, is to continuously improve the quality of the performance and interpretation of echocardiography. To this end, the ASE is a founding member of the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL), which seeks to set and maintain basic standards of care and practice. Nearly half of the ASE’s members either work in ICAEL-approved laboratories or in those with applications in progress.
While the echocardiography laboratory is certainly the most critically important locale for ensuring quality, another essential component lies outside the echocardiography laboratory. Better understanding of the appropriate roles and benefits of echocardiography and its impact on health-related outcomes is needed. This includes appropriate test ordering by the referring physician and proper interpretation and application of the information gained from this diagnostic imaging study.
Perhaps related to the growing recognition of the need for quality standards, all healthcare providers are increasingly accountable for their performance. The Institute of Medicine’s (IOM’s) 2000 study on medical errors has brought great pressure to bear, which is manifest, in part, in the form of performance measures, which will be with us increasingly in the future. ASE will continue to set standards and encourage quality improvement in this and other ways and has been instrumental in the development of physician examinations that certify competence in echocardiography. The National Board of Echocardiography (NBE) offers the Examination of Special Competence in Adult Echocardiography (ASCeXAM) and the Examination of Special Competence in Perioperative Transesophageal Echocardiography (PTeXAM) developed in conjunction with the Society of Cardiovascular Anesthesiologists (SCA). A new membership category for physicians and sonographers was launched in 2002 – Fellowship in the American Society of Echocardiography (FASE) is a single credential, combining test performance, years of professional achievement and recognition by one’s peers.
It is impossible to discuss quality without emphasising ‘people’. The proper performance of an echocardiogram takes the contributions of a variety of individuals to provide the right care at the right time. The ordering physician begins the process by selecting patients who will benefit from echocardiography. Subsequent steps involve a scheduling secretary, a sonographer to acquire images, perhaps a nurse to start an intravenous line and give a contrast agent, a physician to interpret them, another secretary to type the report and, finally, back to the referring physician who will put the findings to use at the patient’s bedside. A properly performed echocardiogram really does require a team of individuals, each with their own unique contribution and area of responsibility. The actions of each are critical to achieving the goal of quality.
- ASE membership survey data, 2003.
- Medical Economics.