Enhancing Inpatient Echocardiogram Request Appropriateness and Timeliness Using British Society of Echocardiography Guidelines: A Quality Improvement Project

IntroductionInpatient echocardiography is an important component of cardiovascular assessment, but inappropriate requests and inadequate clinical information may complicate prioritisation and delay diagnostic imaging.This quality improvement project aimed to improve the appropriateness of inpatient echocardiography requests in accordance with British Society of Echocardiography (BSE) guidance and to improve the timeliness of echocardiogram completion. MethodologyThis was an uncontrolled before-and-after quality improvement study conducted at Colchester Hospital, England, using two measurement points.The baseline audit covered 15-24 March 2025, and the reaudit covered 6-15 June 2025.The latest 100 eligible inpatient echocardiography requests from each period were reviewed using a pragmatic sampling approach.Pre-operative and peri-operative requests and requests relating to patients who had been discharged before audit assessment were excluded.The intervention, delivered between April and May 2025, comprised clinician education, dissemination of BSE guidance and baseline findings by email, educational posters, and teaching sessions.Appropriateness was assessed against BSE recommendations by a single cardiology consultant blinded to the audit period.Time to completion was measured from the recorded request timestamp to echocardiographic image acquisition. ResultsAppropriate requests increased from 82/100 (82%) at baseline to 90/100 (90%) at reaudit, an absolute change of 8 percentage points (95% CI -1.7 to +17.8; Fisher's exact p=0.153).Completion within 24 hours changed from 77/100 (77%) to 79/100 (79%), an absolute change of 2 percentage points (95% CI -9.5 to +13.4; Fisher's exact p=0.865).The median time to completion was 14.8 hours (IQR 5.6-21.4) at baseline and 17.5 hours (IQR 3.3-23.4)at reaudit.Retrospective BSE urgency adjudication classified 71/100 (71%) baseline and 77/100 (77%) reaudit requests as urgent.Among urgent requests, 55/71 (77.5%) at baseline and 59/77 (76.6%) at reaudit were completed within 24 hours. ConclusionFollowing the implementation of a guideline-based educational intervention, an increase in request appropriateness was observed, while overall completion within 24 hours changed only modestly.The findings support continued use of guideline-based education and iterative audit while highlighting the need to evaluate service-level and process measures when assessing echocardiography timeliness.