Position statement: Departmental standards and accreditation; a journey of echo service accreditation

Published 16/05/2024

Echocardiography is a vital, near patient test which combines advanced artistic and scientific skills for accurate image acquisition and interpretation. There is variable image quality between patients and subjective assessment of pathology with frequently performed measurements also subject to error and variable uncertainty of measurements which are not easily appreciated by the clinicians reading echo reports and interpreting results for patients. The British Society of Echocardiography (BSE) sets, examines and maintains the internationally recognised gold standard for patient care in the field of echocardiography and seeks to minimise subjectivity by providing robust personal accreditation processes, and various minimum and comprehensive datasets and pathology assessment guidelines. Following personal accreditation with the BSE, an echocardiographer’s practice is largely independent. In the UK, the report produced by the echocardiographer following the test will enter the medical record unchanged and without any form of additional oversight. Uniquely, echocardiographers are drawn from both externally regulated professional groups (often, but not exclusively medical) and professional groups afforded no external statutory regulation (often but not exclusively scientific). It is for these reasons that we consider echo service quality frame-working to be core to our function; guiding individual practitioners but also maximising the likelihood of safe practice through the framing of a safe service.

In recognition that even individually accredited echocardiographers could not provide safe, effective or high-quality care without the appropriate facilities, staffing, equipment or governance structures around their service, BSE established its Departmental Accreditation (DA) framework in 2004. This has now developed into five standards for DA covering TTE, TOE, Stress echo, Training and Emergency Echo. BSE have also recently launched the Echo Quality Accreditation (EQA) as a step towards BSE DA to encourage all echo providers to place ‘improving patient care’ at the centre of their service and begin their journey of accreditation.

Both Departmental and Quality Accreditations provide a peer-review system with formal review and recommendations provided by voluntary assessors on behalf of BSE. These accreditations are well recognised as a benchmark for high quality in the field of echocardiography. Given the five-year term of accreditation, this accreditation provides some assurance that the service is robust but cannot serve as a guarantee of quality for all patients. Many echo departments also offer wider cardiac physiology services and BSE DA does not assess these services.

In 2012 UKAS established the IQIPS (Improving Quality in Physiological Science) Accreditation scheme. This scheme uses the IQIPS standard to assess the organisations’ whole management system including governance, health and safety, clinical, facilities and patient experience processes. UKAS is the sole accreditation body appointed by government, widely recognised as the gold standard for accreditation however it does involve significant effort to implement despite its advantages for services. BSE support the IQIPS scheme and recognise this high standard of accreditation in cardiology and other physiological sciences and the benefits this brings in assuring safe and effective care. BSE are represented on the UKAS IQIPS accreditation clinical advisory group. As such, many of the echo specific standards are shared and so any department with BSE DA is likely to meet many of the IQIPS requirements for when a department then engages with the wider UKAS accreditation. Recently the UK government has proposed a requirement for all community diagnostic centres (CDC) and their host organisation (if applicable) to be UKAS Accredited within two years of service delivery. Taking into account that some of the CDCs have been in operation for two years, this timescale is challenging . The BSE proposes a journey of accreditation for echo providers with a step-wise approach to improving patient care and achieving some level of accreditation for echo services, whilst developing the processes and culture necessary to ultimately achieve IQIPS Accreditation;

  1. BSE Echo Quality Accreditation
  2. BSE Departmental Accreditation
  3. UKAS IQIPS Accreditation

Centres that demonstrate that they are working towards and achieving each of these accreditations in turn will have created a culture of patient centred care thus encouraging colleagues to improve services for patients and provide safe and effective care.

BSE Advisory Council and Trustees April 2024

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