Quality improvement initiative in paediatric echocardiography laboratory in a low- to middle-income country

Document Type



Paediatrics and Child Health


Objective: To determine the impact of quality improvement (QI) initiative in the area of pediatric echocardiography in a low to middle income country (LMICs).
Background: Care for patients with congenital heart disease is challenging especially in LMICs. Collaborative learning through QI projects is imperative to ensure improvement in delivery processes leading to better patient outcomes.
Methods: This QI initiative was taken by a team consisting of physician and sonographers. Problems were identified, a key driver diagram (KDD) was created, and simple process reengineering was done using interventions based on the KDD. Metrics (5 process and 1 outcome) were assessed to determine the effectiveness of the QI project. The process metrics assessed were comprehensiveness of exam, timeliness of reporting, diagnostic accuracy and error, and sedation adverse event rates of transthoracic echoes while a novel comprehensive echocardiography laboratory quality score was developed as an outcome metric. Data were collected quarterly and analyzed in the post-implementation phase.
Results: Significant improvement was seen in comprehensive mean score (20.4 to 29.7), timeliness (40% to 95%), diagnostic accuracy rate (91% to 100%) while a decrease was seen in diagnostic error rate (7.5% to 3.5%) and the sedation adverse events rate (6.8% to 0%), pre vs post implementation. The overall quality outcome score improved from 7 to 19 and the Echo Lab was able to achieve adequate quality.
Conclusion: Significant improvement was seen in all the processes, and overall quality of the Echo Lab without any substantial increase in resources or cost.

Publication (Name of Journal)

European Heart Journal - Quality of Care & Clinical Outcomes