Shubhika Srivastava, MD, FASE

Leo Lopez, MD, FASE

In an effort to evaluate the infrastructure for personnel, equipment, and workflow in academic pediatric echocardiography laboratories, the ASE Pediatric and Congenital Heart Disease Council board established a working committee in 2010 comprised of Meryl Cohen, Wyman Lai, Peter Frommelt, and Vivek Allada to systematically study current trends in pediatric echocardiography laboratory organization and clinical productivity. The group, also known as the Committee on Pediatric Echocardiography Laboratory Productivity (C-PELP), then developed a survey that was sent to 74 North American pediatric echocardiography laboratories with the following aims: (1) to establish a standard way to evaluate the annual volume per laboratory based on the total numbers and the types of echocardiographic studies performed; (2) to determine the average number of studies performed daily and annually by pediatric sonographers; (3) to evaluate the clinical productivity of echocardiography physicians; and (4) to identify factors that influence physician productivity.

The survey was not meant to establish standards for pediatric echocardiography laboratory productivity but rather provide lab directors with a summary of current practices. Fifty-four responses were received, the data were analyzed, and the survey results were recently published in the Journal of the American Society of Echocardiography (JASE). The working group, as well as the results of its survey, sparked substantial interest and discussion among the pediatric and congenital echocardiography community, and a meeting for all pediatric echocardiography laboratory directors was held at the ASE 2012 Scientific Sessions in National Harbor, MD, where the preliminary results were presented.

The analysis revealed the following: the average number of studies per physician full-time equivalent per day was 15.0 ± 4.5 with a median of 13.8 and a range of 6.2 to 27.1, and the average number of studies performed per year by a sonographer was 1,297 ± 326 with a median of 1,279 and a range of 717 to 2,475. These figures were not adjusted for case complexity, time requirement for transesophageal or fetal echocardiography, level of expertise, availability of sonographer assistance, and additional responsibilities of the physician assigned to read echocardiograms. The publication did not evaluate issues associated with study quality and accuracy, nor did it account for the educational and research activities in each individual center. In addition, it did not address relative value unit (RVU) and other fiscal productivity benchmarks because of the complexity and heterogeneity in physician clinical activities and institutional productivity standards.

A second meeting for pediatric echocardiography laboratory directors was convened at ASE 2013 in Minneapolis with the following goals: (1) to identify the members of the next survey committee; and (2) to determine which topics should be included in the next survey, whether they are recurring issues or newer ones. The following topics were suggested at the meeting:

• 1.
  

  Continued assessment of laboratory workload in terms of volume and staffing (physician, sonographer, and ancillary support)

  
  
• 2.
  

  Evaluation of echocardiography workflow efficiency

  
  
• 3.
  

  Definitions of complete versus limited studies

  
  
• 4.
  

  Identification of vendor-specific issues with the most commonly used echocardiographic equipment, particularly as they pertain to evaluation of children and adults with congenital heart disease

  
  
• 5.
  

  Identification of vendor-specific issues with the most common digital archiving and reporting platforms, particularly as they pertain to pediatric and congenital echocardiography laboratories

  
  
• 6.
  

  Education of pediatric cardiology and advanced imaging fellows

  
  
• 7.
  

  Quality improvement processes in pediatric echocardiography

The new members of C-PELP to conduct the next survey are Vivek Allada (Pittsburgh), Wyman Lai (New York), Adel Younoszai (Denver), Craig Fleishman (Orlando), Brian Soriano (Seattle), and Shubhika Srivastava (New York). At the end of the meeting, it was decided that the next survey would address and collect data on the following topics:

• 1.
  

  Laboratory volume and personnel

  
  
• 2.
  

  Equipment and digital archiving and reporting platforms

  
  
• 3.
  

  Laboratory workflow – protocols, scheduling, indications

  
  
• 4.
  

  Factors influencing the need for more personnel and equipment

Other topics would potentially be addressed using forums or communities on connect@asecho.org .

The next survey will be drafted and sent to all echocardiography laboratory directors by February 2014. This will provide them time to evaluate their institutional data from 2013 that would be needed to answer the survey questions, specifically those pertaining to study volume, personnel, and equipment. Prior to the survey, the committee will send a data collection sheet in December 2013 in order to familiarize everyone with the data that will be necessary for the new survey. In preparation for the survey, the committee encourages all echocardiography laboratory and noninvasive imaging directors to email Andrea Van Hoever at avanhoever@asecho.org stating your interest. If all completed surveys are submitted by April 2013, then the preliminary results may be available in time for the ASE 2014 Scientific Sessions in Portland.