Antonio Hernandez, MD, MSCI, FCCM, co-authored an article* titled “National Certification in Critical Care Echocardiography: Its Time Has Come.” It is featured on the front cover of the November issue of Critical Care Medicine.
Along with being senior author of the article, he serves on the National Board of Echocardiography, where they are developing the formal examination, standardization and certification process for focused echocardiography.
Focused echocardiography uses ultrasound to view the heart and lungs and is used in emergency and critical care medicine to identify problems quickly and see if treatment is working. Hernandez explained the exam performed by the cardiologist is very specific and provides valuable diagnostic information. “The focused echocardiogram exam is directed towards assessing changes in cardiac function. You may give a medication to a patient and repeat the focused echocardiography exam 30 minutes later to evaluate if the patient is responding to therapy.”
The article discusses the importance of formalizing focused echocardiography standardization. Dr. Hernandez said that as the exam has become popular, there is a danger of someone acquiring poor quality images or incorrectly interpreting quality images.
“For example, when a pregnant patient receives an ultrasound for assessment of her baby, the process and images are standard, regardless of the clinic or hospital in which she receives care. Our aim is to standardize a process so that certification in focused echocardiography will yield a reproducible quality focused echocardiography exam with little variability. This standard will require expertise in basic knowledge and a skill set related to focused echocardiography” he said.
Dr. Hernandez said at this time certification is not required to perform focused echocardiography, but the existence of this certification will set a bar and likely promote a healthy competitive environment that may lead to strong collaboration and communal education efforts in healthcare fields where focused echocardiography plays a role. “The absolute goal is to improve quality. We want to make sure people who perform a focused echocardiography exam deliver a quality exam.”
He explained that recognizing a specific problem in a patient that is in extremis often requires rapid administration of therapy, and ultrasound has been used to improve our ability to make a diagnosis in emergency or critical care medicine. “As this technology becomes more common in our clinical environments, I suspect we may observe an improvement in care and possibly patient outcomes,” he said.
The development of the focused echocardiography examination and certification process will have contributions by Dr. Hernandez. He is currently one of the authors of the examination, the chair of the Society of Critical Care Medicine Fundamentals and Live Advanced Ultrasound Courses, and a chair of the Ultrasound Committee. He said because of this, he was appointed to serve on the National Board of Echocardiography Committee.
There will be two parts to the certification, the cognitive exam and verification of practical skills. The first exam will be offered in January 2019.
“We are trying to create a certification process that is fair, with milestones that can be achieved at most institutions without compromising quality,” he said. “As members of the committee for the National Board of Echocardiography, we have agreed not to compromise on quality.”
*Díaz-Gómez JL, Frankel HL, Hernandez A. National Certification in Critical Care Echocardiography: Its Time Has Come. Crit Care Med. 2017 Nov;45(11):1801-1804. doi: 10.1097/CCM.0000000000002707. PubMed PMID: 29028695.