Impact of the COVID Pandemic on Quality Measures in a Pediatric Echocardiography Lab

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.