Impact of the COVID Pandemic on Quality Measures in a Pediatric
Echocardiography Lab
Abstract
Background: The risks for exposure to suspected and confirmed COVID
patients during transthoracic echocardiograms (TTE) led us to endorse an
abbreviated scanning protocol. We sought to determine whether this
impacted the TTE quality measures that were being followed in our lab
prior to the pandemic. Methods: Data were collected retrospectively for
four quality measures reported quarterly in our lab: Diagnostic error
rate, Appropriateness of initial outpatient TTE orders and American
College of Cardiology Initial TTE Image Quality Metric (IQM) and
Comprehensive Exam Metric (CEM). These measures were compared between
two similar quarters in pre-COVID (2019) and COVID era (2020) for
non-COVID patients. Additionally, IQM and CEM of 40 TTEs in COVID
patients were compared with those of non-COVID patients. Results: The
IQM and CEM scored significantly less in COVID patients compared to
non-COVID patients (p<0.001 for both). Systemic and pulmonary
veins, pulmonary arteries and arch were not adequately evaluated in
COVID patients. In non-COVID patients, there were no significant
differences in the IQM and diagnostic error rate but improvement in CEM
and appropriateness of TTE orders from 2019 to 2020. There was no
significant change in TTEs ordered for Rarely Appropriate indications,
but the proportion of those ordered for syncope, palpitations and
arrhythmias increased in 2020 compared to 2019. Conclusion: Though the
diagnostic error rate did not change during the pandemic and the
proportion of TTEs ordered for appropriate indications increased, the
imaging quality in COVID patients was significantly compromised,
especially for systemic and pulmonary veins, pulmonary arteries, and
arch.