Optimizing echocardiography workflow to increase access to high quality care for patients
C Alonso Casero, R Salguero-Bodes, S Capdeville, R Echeverria, S Casalvazquez, A Velasco de Andres, S Diaz Molero, N Garcia Barrio, J L Cruz Bermudez, F Arribas, J SolisAbstract
Introduction
Advancements in echocardiography generate a tremendous amount of data. In order to manage this information and have an impact on patients, we must optimize the workflow by creating a fast and efficient one with interoperability among systems. The study aimed to assess the impact of easy-access data, orchestrated workflow, and measurement automation on efficiency and quality of diagnosis and reports in the echocardiography department. (Figure 1)
Methods
Cardiac ultrasound (EPIQ CVx/Affiniti CVx; Philips) for image acquisition; Ultrasound Workspace (TTA2.5X; Philips) for automated measurements, and IntelliSpace Cardiovascular Information System (ISCV >2.x; Philips) for accessing images/data analysis and reporting were used. Transthoracic Echocardiogram (TTE) measurements were: left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left atrial (LA) volume, right atrial (RA) area, A wave, E wave, lateral E’ (Lat E’) wave, aortic root diameter, ascending aorta diameter, and automatic global longitudinal strain (auto-GLS). We compared the data before (G1: 2018-2019) and after (G2: 2024-2025) full adoption of ISCV and automated tools. Efficiency (median time from acquisition to final report time and time per measurement), quality of diagnosis (number of measurements that support the diagnosis), complex case management, and sonographers’ impact (comparing between periods and with physicians) were evaluated.
Results
A total of 61,879 TTEs were retrospectively analyzed. Our data showed a 20% increase in the number of studies (P<0.001). Regarding efficiency, a significant reduction of 7 minutes (P=0.01) in reporting time was observed after ISCV full adoption. Additionally, there was an increase (40%) in measurements supporting the diagnosis, for instance, an increase (G1:0.5%&G2:8.9% p<0.001) in auto-GLS measurements. Sonographers performed 36,426 studies (G1:14,107 vs G2:22,319; P<0.001), representing a 58% increase in their workload, and reduced their time per measurement by 30% (P<0.001) while acquiring 14 more measurements per study than physicians. Furthermore, the echocardiography unit increased its highly complex cases by 50% with sonographers doubling their complex case volume from 4,158 to 8,528 examinations (P<0.001), effectively absorbing all additional complex workload. (Figure 2)
Conclusions
Speeding up the echo workflow and using automated tools can reduce the time from acquisition to final report while improving diagnosis, which could increase physician-patient time and enhance the patient experience. Furthermore, sonographers have been proven key in workflow optimization as they consistently work more efficiently post-implementation.Figure 1.Workflow diagramFigure 2.Case volume by role and complexity