Improving Efficiency in the Inpatient Echocardiography Laboratory: A Quality Improvement Project

Pediatric echocardiograms are performed daily on inpatient hospital units. Understanding the precise study indication from ordering providers is critical for completing imaging. Given the daily volume of echocardiograms, timely completion of imaging is important for maintaining efficiency and productivity. This study sought to identify areas to improve efficiency using quality improvement methodologies. SMART aim was to decrease the total echo completion time by 10% within 6 months. Fishbone diagram identified ordering system limitations and inadequate ordering provider knowledge as areas for improvement. Primary process and outcome metrics included total echo completion time, pre-echocardiogram buffer time, and specificity in order documentation. PDSA 1 implemented electronic order updates for increased specificity with a picklist of common reasons for inpatient echocardiograms. PDSA 2 implemented an ordering alert for STAT studies to reduce the number of inappropriate orders. PDSA 3 implemented additional order updates and staff education. Total echo completion time decreased each cycle for total 34% reduction. The pre-echocardiogram buffer time similarly decreased 59%. The documentation of pertinent clinical history increased by 15% and maintained at 99% appropriate documentation for the final two PDSA cycles. Pre and post intervention surveys indicated an overall improvement in the ordering process for both the inpatient ordering providers and echocardiography laboratory staff. Echocardiography laboratory efficiency improved throughout the course of this project without identified negative effects on ordering providers or echocardiography staff. Our project demonstrates the ability to affect clinically relevant improvements utilizing simple workflow process changes in the pediatric echocardiography laboratory.