Standards for Provision of Echocardiography in Ontario

In 2005, the Canadian Society of Echocardiography and the Canadian Cardiovascular Society jointly published guidelines regarding the provision of echocardiographic services in Canada. Those guidelines, which were reviewed by a diverse group of echocardiography experts, addressed all components of service delivery and were intended to ensure the utility, reliability and safety of echocardiographic examinations. In 2012, the Cardiac Care Network of Ontario developed standards, taking into account advances in technology and clinical applications.

Following the original publication of this document, the Cardiac Care Network of Ontario, now CorHealth Ontario, established an Echocardiography Quality Improvement (EQI) Program to help facilities achieve the Standards. That process provided opportunities to assess the applicability, clarity and clinical relevance of the Standards. Those insights, together with very valuable feedback from physicians and sonographers undertaking the process, has allowed us to further refine the Standards to both augment their relevance to the practice of echocardiography, and the validity of the review process.

An update was undertaken early in 2015, and again in 2021. The current Standards for Provision of Echocardiography in Ontario have been refreshed to provide greater clarification and align content to reflect current practice.

This document specifies required practices for adult Transthoracic, Stress and Transesophageal echocardiography.

The Standards

The Standards document can be accessed by clicking the link below:

• Standards for the Provision of Echocardiography in Ontario (2021).

Recent Updates

Key revisions from the previous version have been noted below, however it is important that the Standards be reviewed in their entirety.

• A quantitative measurement of Ejection Fraction (preferably quantitated by Simpson’s biplane Method of Discs) shall be now performed as part of the Stress echo screening exam under Standard ES2.2: Required Measurement.
• Capability to share exams externally with interpreting physicians, and other health care providers to ensure continuity of care is an expectation now captured in Standard F7b: Capability to Share Exams Externally.
• Standard P7: Qualifications of Medical Staff has been updated to include requirement for recent Level 2 or 3 echocardiography training, or supervised practice at an accredited facility.
• Under Standard P10: Technical Staff Requirements, the Technical Staff meet the qualification requirements by achieving 1) appropriate credentials, or 2) successful completion of an accredited Echo training program, or 3) recently completed an accredited echo training prior to qualifying for American Registry for Diagnostic Medical Sonography (ARDMS) or Sonography Canada, or equivalent credentialing.
• Providing patient-centered care is best practice, therefore, a mechanism to monitor patient satisfaction is an expectation now included in Standard Q7: Patient Satisfaction.

Additional requirements have been included under the following Standards:

• Standard E4: Standard Measurements
• Standard ES2: Established Protocols for the Screening Examination
• Standard ES3.1: Pharmacologic Stress Echocardiography
• Standard ES4: Additional Important Considerations
• Standard F1: Examining Room Requirements
• Standard F3: Maintenance Requirements
• Standard P1.1: Additional Qualifications for Stress Echocardiography (Medical Director)
• Standard P7.1: Additional Qualifications for Stress Echocardiography (Medical Staff)