Madhav Swaminathan, MD, FASE, FAHA

Alina Nicoara, MD, FASE

As healthcare providers of patients with cardiovascular disease who are undergoing surgery, it is our job to ensure the quality of care they receive. Whether we are anesthesiologists who take care of the patients throughout the perioperative period, or cardiologists or sonographers responsible for the imaging portion of the procedures, our commitment to quality remains unquestionable. But what are the essential requirements of quality that we must consistently meet? What are the definitions of quality we should follow? The Institute of Medicine has defined quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. Quality in echocardiography has also been defined previously. The ASE has led the way in translating the continuous quality improvement (CQI) process from standardized business practices to the field of echocardiography, including perioperative echocardiography. However, defining the process is just the preliminary step toward the goal of achieving constant and consistent quality care. These definitions form the basis for the continuous implementation and evaluation of defined processes for our quality care goals. The extent to which these guidelines are followed remains unknown, especially in the perioperative arena. One method of ensuring quality is to have an unbiased entity certify the processes followed by an echo laboratory as consistent with acceptable quality standards. The Intersocietal Accreditation Commission (IAC) is one such entity that has a framework for assuring the delivery of defined quality metrics in echocardiographic imaging to healthcare consumers. While accreditation standards for adult, pediatric, transesophageal, and stress echocardiography are clearly defined by the IAC, similar standards for perioperative echocardiography are conspicuous by their absence.

To patients and payers alike, echo laboratories that are IAC accredited can demonstrate echocardiography practices that indeed follow industry benchmarks. However, perioperative echocardiographers cannot confidently claim similar standards.

Surgical patients present with pathology that has usually reached the endpoint of medical management and are a unique challenge for echocardiographers. Patients are frequently elderly, unstable or present rapidly fluctuating hemodynamic conditions. Echocardiography, most often transesophageal, can be crucial in the immediate assessment of surgery and assurance of adequate surgical repair. These patients require the highest quality in imaging to ensure optimal outcomes. While quality metrics are comprehensively defined for surgical, anesthesia and critical care practice, they are largely absent for intraoperative echocardiography.

We at the ASE Council on Perioperative Echocardiography (COPE) are deeply committed to the development of a process that enables echo laboratories to be accredited in accordance with established ASE standards. The council is working with the leadership of the ASE, Society of Cardiovascular Anesthesiologists (SCA), and IAC to develop guidelines that would eventually lead to minimum standards for accreditation in perioperative echocardiography. Our commitment to quality in echocardiography that started with the definitions of CQI will continue with accreditation standards in perioperative echocardiography, eventually leading to quality care and optimal outcomes for the surgical patient.