Image Audit as A Part of a Quality Assurance Program is Feasible in a Large, Busy Australian Private Practice Across Multiple Sites, and Produces a Measurable Improvement in Study Quality

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Introduction: Echocardiography requires acquisition of standard imaging planes to ensure accuracy and reproducibility. An extensive quality assurance program was established at HeartCare Partners in 2013 including a comprehensive image audit. Method: Quarterly image audits were conducted on 5% of all transthoracic echocardiograms performed at HeartCare Partners’ 7 clinical sites by 2 other randomly selected experienced sonographers. Studies were assessed for completeness of image protocol, on-axis and full cardiac cycle capture. Automated data analysis was presented at quarterly in-house meetings. Result: 977 studies performed from April 2013 and December 2015 were analysed. 6/11 standard views were identified where on-axis imaging was below 80% (average 68±6%) on first audit. Subsequent audits showed an increase to an average of 81±5% (p<0.001). 4 views with values above 80% (average 83±1%) showed no significant change (85±7%, p>0.05). One view (apical 5-chamber) identified as having been obtained in 83% of initial studies rose to 98%. Other views (average 96±3%) were unchanged (1±1% p>0.05). Appropriate capture of at least one full cardiac cycle remained high and relatively unchanged (95±0.02%, p=0.02). Conclusion: Image audit is scalable and practical over a period of years and appears highly effective in improving and maintaining quality. The program has now been extended to 25 GenesisCare locations across 3 states with further expansion ongoing.