A quality control exercise in the echo laboratory: Reduction in inter‐observer variability in the interpretation of pulmonary hypertension. Issue 12 (19th September 2017)

• Record Type: Journal Article
• Authors: Patton, Daniel M.; Enzevaie, Atoosa; Day, Andrew; Sanfilippo, Anthony; Johri, Amer M.
• Is Part Of: Echocardiography. Volume 34:Issue 12(2017)
• Page Start: 1882
• Page End: 1887
• Publication Date: 2017-09-19
• Subjects: continuous quality improvement -- pulmonary hypertension -- right ventricular systolic pressure -- transthoracic echocardiography; Echocardiography -- Periodicals; Echocardiography -- Periodicals; 616.1207543
• DOI: 10.1111/echo.13712
• Languages: English
• ISSNs: 0742-2822

Abstract

Abstract : Background: Right ventricular systolic pressure (RVSP) estimated by echocardiography is critical for the initial screening and follow‐up of pulmonary hypertension (PH). Inter‐observer variability (IOV) in RVSP can impact clinical decision making. This study assessed whether a simple guideline‐based teaching intervention could reduce the IOV in RVSP interpretation. Methods and Results: Eleven participants in a high‐volume tertiary level echocardiography laboratory underwent an assessment of the baseline IOV in the assessment of RVSP for a series of transthoracic echocardiograms (TTE), depicting various degrees of PH among 8 cases each before and after a teaching intervention. The inter‐observer variance (root‐mean‐square error) decreased from 26.0 mm Hg 2 (5.1 mm Hg) at baseline to 5.8 mm Hg 2 (2.4 mm Hg) post‐teaching intervention ( P = .025). The corresponding inter‐class coefficient (ICC) increased from 0.89 to 0.98. Several factors relating to image acquisition and interpretation were identified as contributing to IOV in RVSP. The outcome was the development of a practical tool to mitigate these factors. Conclusions: A simple structured teaching intervention successfully reduced IOV in the measurement of RVSP in a high‐volume echo laboratory.