Optimizing echocardiography workflow to increase access to high quality care for patients
Authors: Solis J S , Fahimeh Falahi F F , Garcia Casado S G , Rodriguez Martinez M R , Salguero Bodes S B 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Advancement in echocardiography has led to creation of tremendous amounts of data, while such data informs diagnosis/treatment decision, it is resource-intensive and time-consuming to access and analyze. This calls for a fast and efficient workflow with interoperability among systems. Aim: to assess impact of a fast workflow, easy accessing data and measurement automation on time saving, increased number of studies and more specific measurements.

Methods
98290 TTE was retrospectively analyzed. TTE were performed by cardiologists and cardiac sonographers. EPIC CVx/Affiniti CVx (Philips) were used for image acquisitions; Workspace (TTA2.5X; Philips) for automated measurements (manual prior 2020), and IntelliSpace Cardiovascular Information System (ISCV &gt;2.x; Philips) for accessing images/data analysis and reporting. Measurements were: LVEDV, LVEF, LVEDD, LA Volume, RA Area, A Wave, E Wave, E’ Wave, AO Root Diam, AO Asc Diam. Data were divided into two time-windows: Group 1 (G1) TTE between 2018–2019, when CV Imagine unit had manual tools (ACMQ; QLAB; Philips); Group 2 (G2) TTE between 2020–2021 after full adaptation of ISCV and automated tools (AutoStrain, LV based Philips TT/UWS technology). Data was expressed as mean±SD. Two tailed Student T-test was used for statistical significance (p&lt; 0.05).

Results
Operational efficiency: there was a slight increase in number of studies after ISCV full adoption (G1: 23946.5 ; G2: 25198.5; p = 0.4) (Fig 1, left). Comparing both groups, G2 showed a significant reduction on time spent from acquisition to final report (31%) (G1: 113.0h ±19.5 vs G2: 77.5h± 2.5; P= 0.039) (Fig 1, right). This was associated with a consistent and predictable workflow as the average time of acquisition to final report was more consistent in G2 compared to G1 (smaller standard deviation in G2). In terms of first-time right,data showed that 93 to 94% of reports were finalized in one version. The reports finalized in one version has an increasing trend over the years and it is more highlighted in G2. While there was an increase in preforming exams by sonographers (G1: 12%; G2 16%), quality and first-time time right in G2 remained high.Quality of diagnosis-Upon full adoption of automated tools within ISCV, there was an increase in measurements that supports the diagnosis (G1=63.3 G2=67.8, p = 0.052) (Fig 2, left), in this regard, there was 6 times more strain measurements after introducing Autostrain (p = 0.005) (Fig2, right).

Conclusions
Using automated tools and speeding up the echo workflow can help reduce time of acquisition to final report, enable quality measurements such as strain, enable sonographers to perform more exams while quality remains high, free up more time for physician-patient time, improve patient experience, and provide consistency in the workflow helping scheduling. Reasons for the observed time saving can be automation of measurements, data in one place and less turn-around time in searching for the data.