Quality Assurance

How long should an echo take?

I am often asked, “How long should an echo take??”.

Trainee sonographers want to know if they are on track, overworked sonographers often ask before approaching management to address workplace issues, practice managers are interested in the answer to aid with rostering and timetabling. I am interested in the answer as I campaign for improved quality of our scans. Patients are interested in the answer to know how long they are going to be stuck in our room…. There seems to be an endless number of reasons for asking the question, and unfortunately the answer upsets more people than it pleases.

The truth is that it takes as long as it takes. Not very helpful advice, I know… So I guess the real question that we should ask is, what is a reasonable allocated booking time for a routine adult transthoracic echo?

The literature doesn’t offer a lot to help guide us. The American Society of Echocardiography (ASE) recommendation is that we should allow 45-60 minutes for a normal routine echo with longer time required for complex valvular pathology or reporting.

Read the full ASE “Recommendations for Quality Echocardiography Laboratory Operations” here.

Many factors will influence the duration of a scan…….patient compliance, body habitus, difficulty in obtaining a window and complexity of pathology… Obviously we can’t predict which patients are going to need longer to obtain images at the time of booking, so allocated slots will represent an average of scan times over a variety of patients and pathologies. Some scans will be completed well under the allocated slot, and some will run overtime. We also need to consider what is expected as part of the scan. Advanced measurements (such as 3D volumes, contrast, strain imaging etc) will require an additional allocation of time. It is also unreasonable to expect student or trainee sonographers to scan within this time frame either.

I should also add at this point that I strongly advocate performing all measurements online whilst the patient is still present. This is a whole other discussion topic altogether! There are many exceptions to this rule (acutely ill pt for example) but measurements while the patient is still present really should be the routine. I therefore expect that in the allocated time, all measurements have been performed, checked for accuracy, and a report written.

The expectation of level of reporting will vary between institutions also, ranging from no report or a simple worksheet with tick boxes all the way through to finished formatted report ready for a final check by a reporting physician. Differences in efficiency in reporting packages also confound this aspect of the examination. In my practice, I allow 10 minutes to complete the report, which normally leaves enough time to stretch the legs and have a short break before starting the next patient. This would also include a side-by-side comparison with previous images if indicated (or available).

Now I know I have lost more than half of my readers by now… 60 minute slots!!! That’s ridiculous!! So let’s look at it differently… What if we have a 30 minute booking time? The time to report is a constant, and I’ll even assume that on average you are twice as fast at reporting than I am, that takes us down to 25mins. On average we lose 5-10 minutes in setting up packing up and cleaning up after a patient (lets say you can get a patient into your room, explain the test, wait for them to get undressed and onto the bed, and then packed up again at the end in 5 minutes). This would include introduction and explanation (consent) for the procedure. That leaves us less than 20 minutes to actually scan the patient. Looking through standard suggested protocols, I would estimate that 80 clips is an average number of clips (the standard protocol in my institution is closer to 100 clips). This means that we have about 15 sec to find an image, optimise, measure and clip before moving on to the next image. That doesn’t leave a lot of time for adequately panning through the valves, controlling patient breathing to optimise the images or struggle to find any windows. Even after many years scanning, I still struggle to find windows or struggle to see endocardium. I would agree that I can acquire all the necessary clips and measurements in a normal patient in 30 minutes, but no one can put hand to heart and say that they honestly panned adequately through the images or gone looking for an alternate (and possibly better) window. I could take 80 pictures in 30 minutes, but I can’t properly assess the heart in that time.

My personal view is that we should allow no less than 60 minute slots for booking times. Some scans will be finished sooner and some will go a little later…. But any faster and we run the real risk of missing pathology, causing injury to ourselves or not allowing enough time to actually stop and listen to our patients. Talking with patients gives important clues that may not be in the request form, and is one of the more pleasant aspects to our profession. Finding the correct answers takes time. If our only goal is to press the clip button 80 times, then we don’t deserve the money we earn. We are professionals and we need to take responsibility for ensuring we adequately (thoroughly) assess the heart and perform a comprehensive examination.

A little controversial, but best we clear that one up from the start… happy scanning!

Echo.Guru

 

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6 Comments

  • Reply Christine Brown November 14, 2014 at 6:58 am

    Thank you Echo.Guru this blog report should be laminated and placed in all labs. Quality aquisition should always take priority The quick flick echo does nobody any favours and does not provide diagnostic information. It is really important that all cardiac sonographers support each other to stand up and demand the time to acquire the best quality aquisition possible.

  • Reply Mark Kehoe November 20, 2014 at 3:09 am

    Not only should this be placed it every lab, it should be handed to every manager, administrator and cardiologist that has anything to do with an echo lab. This is especially true in the pediatric setting. I know things are tight financially, but we need to put the patient first and not profits.

  • Reply Kerry, RDCS November 20, 2014 at 6:19 am

    I agree with Ms. Brown’s and Mr. Kehoe’s thoughts. Other things to consider: US equipment knobology- are you using newer or older equipment. Older equipment may not have all the “bells and whistles,” therefore longer scan times. Also, your lab’s PACS/DICOM software may add to increase time. In the USA, most adult echo labs are running 45-60 minutes per exam. I’ve always told “future sonographers” that an echo exam is like making a movie: Good quality images, quality Doppler signals, and complete the exam (i.e. answer the diagnostic question for the exam). As Ms. Brown alluded to: there is no room for the quick in/out echo exam. Patient care should always be paramount.

  • Reply Jack, Administrator May 2, 2017 at 12:42 pm

    Well many technicians are aware of this expected time span, but the fact is echos are no the only test. There are Carotid Dopplers, Aorta scans and even ABIs which are such a faster study. I know several Echo techs, in hospital and clinics, that can actually do their Echos scans and do the reporting documentation within a 40 minute time span. You tell a tech he has 45-60 minutes, he will be a turtle when he enters his information. The fact is most sonographers should be able to type 30+ words a minute. You can have the required documentation inputted into an EHR system these days in under 10 minutes.

  • Reply betty June 28, 2017 at 10:02 pm

    I had an echo done today and it took precisely 10 minutes. Is this abnormal? Should I be concerned that the echo was not done properly or thoroughly?

    • Reply echoguru July 1, 2017 at 12:46 pm

      This is not an easy question to answer. My website is aimed at providing sonographer education and I can’t comment on particular cases without knowing the whole story. There are many instances where it is completely appropriate to perform an abbreviated or targeted examination. It is common for referring doctors to request a specific clinical question; and it would take less than 10 minutes if that was the only goal of the scan. In some health systems the billing code requested also might be reflective of a targeted examination only. This does not mean that the echo wasn’t performed correctly or thoroughly…the sonographer might have done a fantastic scan and answered the question required. My post on this website is more a commentary around standard booking times, or how long we should allow to perform an echo.
      If you have concerns about the provider of your echo, then I would suggest you raise this with your referring Dr. It is not possible for me, or any of the readers, to comment on these situations without all the information.

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