Successful Incorporation of High Quality Left Ventricular Global Longitudinal Strain Into the Workflow of a Regional Hospital Echocardiography Laboratory

BACKGROUND: As hospitals merge with large healthcare systems, maintaining quality across all echocardiography laboratories has increased in complexity. Since left ventricular global longitudinal strain (LV-GLS) is now available for routine use, some small echo labs may not be performing this technique routinely. We demonstrate the feasibility of an educational intervention accompanied by audit and feedback cycles for sonographers and physicians in a regional hospital to incorporate LV-GLS into their clinical workflow. METHODS: Two physicians and two sonographers with expertise in LV-GLS performed a baseline audit of randomly selected transthoracic echocardiograms with LV-GLS performed at a regional hospital. Technical aspects of LV-GLS acquisition by sonographers and physician LV-GLS reporting skills were scored. Audit results with feedback were shared with the echo lab members. Three pre-recorded educational modules were provided for on-demand viewing. Two subsequent audits and feedback cycles were performed at 2- and 5-months post baseline along with surveys to assess balance measures. RESULTS: The number of sonographers and physicians evaluating LV-GLS increased following the educational intervention and each subsequent audit. The overall median score for physicians improved from 42% (audit 1) to 67% (audit 2) to 100% (audit 3), (p < 0.01). The overall median score for sonographers showed a trend toward improvement from 79% (audit 1) to 81% (audit 2) to 85% (audit 3), (p = 0.11). Surveys revealed that despite LV-GLS images increasing exam duration, neither sonographers nor physicians felt that LV-GLS negatively impacted their efficiency, while both felt it added value to their skillset. CONCLUSION: Providing educational modules and repeat audits with feedback is a feasible method to incorporate new technology into a regional hospital echo lab and is associated with improved performance. This technique can be used to ensure high-quality echo standards across a healthcare network as hospital systems continue to expand.