Echo quality accreditation

Quality assurance (QA) of echocardiographic studies is vital to ensure that clinicians can deliver excellent patient care. Our Echocardiography Quality Framework (EQF) provides a structured yet versatile approach to help departments ensure that high quality standards are met across the board.

What is echo quality accreditation?

Echo quality accreditation consists of four areas of assessment:

  • Echo quality
  • Reproducibility and consistency
  • Education and training
  • Customer and staff satisfaction

Applications are welcome from all echo departments, regardless of size, and including non-BSE accredited departments.

By participating in echo quality accreditation, echo departments can demonstrate that robust QA processes are in place to ensure continual service improvement. 

Assessment process

After registering and paying a small fee , departments can upload evidence of their QA processes and outcomes in each of the four assessment areas. This evidence is then graded and given a red, amber or green rating. An amber or green rating means that a quantifiable level of engagement in that aspect of QA has been achieved. 

Departments that have achieved a grading of amber or green in all four categories are issued with a certificate and digital logo to demonstrate their accredited status. 

This area is about demonstrating that we are regularly reviewing and improving the quality of the echo pictures and reports that we produce. The whole team should be engaged in this process to achieve the best results for improving patient care.

  • Do we review the quality of our echocardiograms and optimise images with the use of sector width, focus, gains, depth ? 
  • Do we review the quality and accuracy of our reports to help the referrer provide better patient care? 

Your discussion of any findings and any resulting changes to practice should be documented.

Grading of evidence
  Echo quality Echo report
Red No evidence No evidence 
Amber
  • Quarterly meetings within the department (minimum of five cases reviewed per meeting) 
  • Evidence provided - e.g. score sheet /  meeting minutes
  • Quarterly meetings within the department (minimum of five cases reviewed per meeting) 
  • Evidence provided - e.g. score sheet /  meeting minutes
Green Evidence as amber, plus documentation of feedback, quality improvement, reassessment. Evidence that the whole team is involved in this process. Evidence as amber, plus documentation of feedback, quality improvement, reassessment. Evidence that the whole team is involved in this process.

This area is about demonstrating that we achieve high standards for every patient in every situation.

Here, variability and audit are key. To achieve maximum results for improving patient care the whole team should be engaged in this process. 

Variability

Variability can be achieved by re-reporting studies. This can be done anonymously if a department wishes. Documentation of results obtained from LV assessment and valve quantification should be recorded, and if there are any discrepancies, training or education should be provided. 

Audit

Audits do not have to be complex. For instance, a department can undertake a simple audit such as:

  • has height and weight been recorded
  • how many individuals have reported on the aortic root in aortic regurgitation patients
  • how long does it take for the report to be despatched after the scan

Any findings, resulting actions and re-reviews should be documented to demonstrate department audit/QA and the overall learning curve.

Grading of evidence
  Variability Audit
Red No evidence No evidence 
Amber One key output variable per year rotating on a five-year cycle (e.g. severity of MR, LVEF, aortic root dimensions)

Two audits per year (these can be simple, e.g. height and weight included in the reports, studies achieving BSE minimum dataset, etc)
Green Evidence that the whole team is involved in this process (documentation of feedback, teaching / intervention as required and reassessment) Evidence that the whole team is involved in this process (documentation of feedback, teaching / intervention as required and reassessment)

This area is about demonstrating that we want to improve education of all users and providers of an echocardiography service, with the overall goal of improving patient care.

This is relatively simple to demonstrate, as most departments undertake training of staff, such as trainee physiologists, scientists, junior doctors, and registrars. A structured training programme can be formalised with evidence including:

  • attendance at training sessions and learning outcomes
  • participation in training, such as regional meetings
  • success in training colleagues to achieve accreditation (BSE level 1 , FEEL, FICE programmes, etc)

Education of service users is also important, such as the GP direct access echo service. Evidence might include a list of indications for requesting an echocardiogram, discussion of a change in guidelines, and how to interpret an echocardiogram. 

Grading of evidence
  Training Teaching
Red No evidence No evidence 
Amber Evidence of any structured training programme and implementation (e.g. BSE level 1, FICE, FEEL, etc.)

Specific Case review, e.g. difficult MR case in the department (20 hours per year)
Green Assessment framework and evidence of successful completion (e.g. BSE accreditation) Evidence of topic teaching (this can include department teaching as well as regional and national)

This area is about demonstrating patient satisfaction and what the people who use our service think of us.

This should not be limited to the patient or carer alone; we also need to consider those that refer to the service. Looking at both aspects will undoubtedly improve patient care

Patient satisfaction can be audited via a questionnaire or feedback exercise. Outcomes of this should be documented, and any arising issues discussed and actioned, with a further review in the future. This evidence is not just useful for the EQF, but can also be provided to local authorities for CQC visits.

Feedback from referrers is also essential as they may have issues that might otherwise be missed, such as the wait time for a scan and obtaining results, or understanding the report. A simple questionnaire or online survey would be adequate to evidence this. 

Grading of evidence
  Service users Patients and carers
Red No evidence No evidence 
Amber

One service user survey within a three-year cycle

One customer satisfaction survey within a three-year cycle
Green Two yearly rolling programmes with action plan Two yearly rolling programmes with action plan

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