QUALITY ASSURANCE FOR INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHYMONITORING - A REPORT OF 846 PROCEDURES

We evaluated our experience with 846 consecutive transesophageal echoc ardiography (TEE) intraoperative monitoring procedures performed betwe en November 1989 and July 1991. TEE frequency was 36 +/- 11 per month (range 16-55) and represented 69.8% of cardiac valve surgery cases, 40 .2% of coronary artery bypass graft cases, and 2.2% of total operative caseload. Major patient complications consisted of transient vocal co rd paresis and ingestion of glutaraldehyde-disinfectant solution. Mino r complications consisted of a chipped tooth (one case) and pharyngeal abrasions (three cases). The Quality Assurance (Q/A) Program evaluate d both record keeping and quality of imaging, as judged by cardiologis t echocardiographer reviewers. The percentage of completion for each Q /A indicator was as follows: medical record documentation, 88%; databa se form annotation, 94%; and provision of videotape recording, 91%. TE E database forms were analyzed further in terms of the percentage of f ields completed. Completion scores were 73%. The following scoring sys tem was utilized for videotape evaluation by the cardiologists: 1 = ex cellent; 2 = good; 3 = poor. The median grade for both two-dimensional echocardiography and color flow Doppler (CFD) examinations was 2. Poo r quality images (grade 3) were present in 15.2% of two-dimensional ec hocardiography and 20.3% of color flow Doppler examinations, and dispr oportionately associated with 4/26 attendings. Supplemental audit of t he cardiology reviewers performance demonstrated 569/846 videotapes sh owed no objective evidence of review. The cardiology reviewer forms of the remaining 277 videotapes were evaluated in terms of the percentag e of fields completed. The completion score was 56%. These data sugges t the need for formal Q/A for intraoperative TEE, both for anesthesiol ogists and reviewing cardiologists.