Site developed by Linda R. Desnoyers MS,RDCS, RDMS, RT(R)

Grade level: Post Secondary Health Science Echocardiography Students

Content area: Echocardiography I

Time Frame: Post midterm-(7 weeks)second half of the fall semester

Project Goals: This project is designed to aid echocardiography students in the development of concepts necessary to complete a cardiac sonography procedure of good quality and high accuracy on a normal technically excellent patient and to work within a team environment towards an end goal. Students will also be involved in the process of understanding and the development of an echocardiography protocol. Students will have prior class and laboratory activities and lectures in the first half of the semester to provide for the foundation to this project.

Introduction:

A protocol http://my.webmd.com/content/asset/miller_keane_27216 is a detailed written statement of the history and treatment of any particular patient; especially one made for a medico legal purpose.The purpose of a protocol is to guide the practitioner in the care or procedure performed on a patient. In any ultrasound department, there is a procedure manual, which includes written protocols for the department's procedures or treatments performed on patients. The purpose of these protocols is to create quality, and consistency between each examination performed by the staff sonographers. It is a set of instructions or directions on how procedures are to be performed. Protocols can be very detailed, or very general. The physicians, administration and staff within the department determine the degree of details included in a protocol. Failure to follow a protocol once established by a department can result in legal consequences between the patient and the institution.

Tasks

You are staff sonographers of Hudson Valley Echocardiography Department. I am the Department Manager of your Echocardiography Department. We have been working as a committee on our departmental self-study document for our laboratory accreditation through the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) http://www.icael.org. According to the ICAEL Accreditation Guidelines, it is necessary for us to develop a departmental protocol for a normal echocardiography procedure following the ICAEL Guidelines and to submit on video tape or digital disk to this agency one normal case study for each staff sonographer from our department following our own protocol.

You will all come together as one group to compose the written departmental protocol document for our department. You will use actual resources of Department Protocols from your clinical affiliation and the ICAEL Website. All departments have such a protocol especially if they are an accrediated laboratory. To accomplish this specific objective, each student sonographer will ask their clinical instructor for a copy of their standard department protocol. As a group you will come together to compare and contrast these protocols. You will submit a detailed document of this analysis including the name of the hospital, separating the categories of requirements such as 1. Purpose 2. indications for the Examination 3. Limitations 4. Contraindications 5. Equipment and Supplies 6. Patient preparation 7. Procedure 8. Protocol 9. Reporting formate. Analysizing these categories to indicate if these 9 elements have been included and how they compare using these 9 elements, any likes and differences of each protocol. You will then proceed to write our own department protocol. Once this protocol is written and approved by me, you will then perform this protocol and submit a tape or disk to me on one normal tecnically excellent subject. This will contribute to your end-term competency for your final grade in clinic.

Process/Activities

You will work as one large group as a whole to complete this project. This project will start the second half of the semester after mid-term. There are four main activities in this process. The first activity is to collect information of a hardcopy protocol document from your clinical affiliations. The second activity will consist of you analyzing this document for all elements. The third activity consists of developing a working protocol that is suitable for our patient population and our department. We will all agree on a final product. Fourth, you will perform the protocol that you have all agreed on in class. Since our lab is seeking accreditation, and we have to submit our tapes to the ICAEL accreditation body, it would stand to reason, that we have to submit only the best quality product. My office hours are available if you need any type of guidance or clarification.

Written Protocol: Criteria you are looking for as well as to be developed in our departmental protocol

a) It is essential that I see the following criteria listed in our departmental protocol: 1. Purpose 2. indications for the Examination 3. Limitations 4. Contraindications 5. Equipment and Supplies 6. Patient preparation 7. Procedure 8. Protocol 9. Reporting formate.

b) Include all applications agreed upon with the group. Such as which 2-D views (make sure you check the ICAEL guidelines)will be included, will you use M-mode or not and which Doppler criteria will you use. Agree upon the type of technical measuring that will be handed in along with each sonographer's case study, on-line video or hard copy or both.

c) Agree on how detailed or how general you will be. Remember, you will have to follow the protocol you decide upon as a group in order to produce your individual videos or digital disk of a normal exam.

d) Use word-processing and make enough copies for everyone.

e) Prepare as a group a 5-minute presentation. Elect a facilitator(s), you as a group will design the presentation and the facilitator will give the presentation. (This person(s) will receive extra credit for presentation). The presentation will consist of the final results of your analysis and your group developed protocol; include reasons for your choice, insights, explanations, conclusions, and/or comments. Include a list who was assigned to which task and contributions (in terms of typing the paper, creating the powerpoint presentation, and list who did what throughout the whole project). Use PowerPoint please feel free to utilize this tool. If you do not know how to create a PowerPoint slide series, I will be happy to tutor you, be

f) Once a departmental protocol is approved, each sonographer will produce one normal case study to protocol. Your protocol will be evaluated under separate criteria (rubics scale), which I will hand out to you under separate cover. At the end of this project you will have the skills developed to assess the quality and accuracy of a normal echocardiographic examination.

Resources:

The list that follows offers possible resources for you to consider in completing this project. You may use any of these as well as related resources of your choice.

I. Background Information:

· ICAEL Standards and Protocol on-line http://www.icael.org/Standards/Adult%20TTE%20Std%20Part%202.pdf

· Textbook of Clinical Echocardiography by Otto and Pearlman

· Diagnostic Medical Sonography; A Guide to Clinical Practice, Echocardiography by Mark Allen

· The Echocardiographer's Pocket Reference by Terry Reynolds

· Examples of actual hospital protocols

III. Additional Resources:

· Experts: Ask an expert a question by e-mailing the individuals below. These individuals are all Registered Diagnostic Cardiac Sonographers who have volunteered to help you, please utilize them.

1. Cathy Denier, RDCS cdenier@nycap.rr.com

2. Patricia Dubrey, RDCSPDubrey@ellishospital.org

3. Christine Kennedy, RDCS ChristineKennedy@med.va.gov

4. Linda Desnoyers, RDCS(Echocardiography Program Coordinator - Hudson Valley Community College) desnolin@hvcc.edu

Evaluation:

The criterion below is for the written portion of this project only. It is worth a total of 100 points X 10% or 10 points = added to your final grade. Extra credit will be assigned as indicated.

The fourth part of this project will commence once a departmental protocol is agreed upon. Each student sonographer, under separate evaluation, which will be established by the class and I, will award points towards your final Echocardiography Clinic I Course ECHO 258 and count as your final clinical competency grade.

Hard copy of the rubrics that will be used for grading will be provided to the class under separate cover

Conclusion:

Because a complete echocardiogram is composed of many factors such as quality, accuracy within each application that is used, and each application builds on each other, it is sometimes difficult for an inexperienced sonographer to conceive all the necessary elements to produce a good quality examination. Through this project and correlating all available resources, it is my hope that you will gain a "real life" experience that will help you to transfer your knowledge and experience when completing an entire examination on a patient.

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