Minimum dataset: comprehensive cardiac assessment where no specific pathology exists requiring additional measurements or views.
Level I protocol: used for the exclusion of life-threatening pathology and triggering of more advanced study or another appropriate test in an acutely unwell patient.
Focussed-repeat echo: a clinically targeted monitoring echo performed with a limited and directed dataset. This should only be undertaken following an initial minimum dataset performed at the first study.
Abridged echo protocols: where selected components of a comprehensive cardiac assessment are undertaken. (Sometimes called abbreviated or screening protocols.)
- This statement updates our position on the use of abridged echo protocols within UK echo services following our Post-pandemic work-flow statement which is available here.
- The BSE advocates the use of triage guidance as the primary tool to manage workload. Our comprehensive triage guidance can be found here.
- We strongly advocate the principle of selecting the correct test for the correct patient at the correct time. Selecting the correct tests prevents unnecessary pressure on departmental echo services. For example, a Level I study should be used to answer specific questions quickly in acutely unwell patient when requested by an attending clinician.
Abridged echo protocols:
- The BSE does not advocate or support the use of an abridged echo protocol in patients who have been triaged using published BSE triage guidance as requiring a minimum dataset study.
- The published minimum dataset for echocardiography is a safety gold standard and outlines the minimum data required to confirm or exclude normal cardiac structure and function. The detection of abnormality should prompt the use of the appropriate BSE guideline to fully assess that pathology.
- There is no published data to support the position that performing part of that dataset is diagnostically accurate or safe.
- There is no published evidence that performing part of a dataset would significantly improve work-flow capacity.
Investigating abridged echo protocols:
Where abridged protocols are being actively researched the following considerations should be made:
- The additional clinical risk is held by that centre or departmental lead
- Missed diagnoses should be counted and assessed and managed on an individual patient basis
- Patients may need to be consented to receive an abridged research protocol
- Work-flow effect should be assessed including time needed for rescanning
- Effect on echocardiographer well-being should be assessed
- Effect on training should be assessed
- Documentation should make it clear that a minimum dataset has not been performed in that patient.
We support the use of focussed-repeat studies in patients who require follow-up for known pathology where a base-line minimum dataset has been performed. An established example of this is Herceptin monitoring: see Cardio-oncology guideline here.
BSE Council and Trustees September 2022