Australian cardiac sonographers' use of industry guidelines when performing a transthoracic echocardiogram

Introduction: Clinical practice guidelines (CPG) are a component of evidence-based practice allowing standardisation across departments and individuals' skill levels. Australian Cardiac Sonographers (ACS) are not obliged to follow specific CPG when performing a transthoracic echocardiogram (TTE). This research aimed to determine guidelines/workplace protocols ACS follow when performing a TTE, and what attitudes, subjective norms and perceived behavioural controls exist that may prevent adherence to guidelines. Methods: A national mixed methods online survey, exploring adherence to and opinions of guideline use when performing a TTE. The ‘Theory of Planned Behaviour’ model (attitudes, subjective norms and perceived behavioural controls) was used to develop the survey. Results: Of n = 131 ACS, 73% reported following a mix of guidelines, practice protocol and doctor preference when performing TTE. The majority followed the American Society of Echocardiography (ASE) guidelines (59%), considered guidelines beneficial (84%) and felt encouraged to adhere to them (56%). Most however (61%) reported finding measurement or pathology discrepancies with their own TTE studies compared with those performed at other practices. Factors negatively influencing guideline adherence included insufficient guideline education, time constraints for scanning and education, leadership influence and lack of quality control. These factors were considered largely workplace dependant. Conclusion: While the majority of ACS do not follow a single specific guideline when performing a TTE, ACS believe guidelines are important. Several negative influences may prevent adherence in different workplace environments. Further examination of national standardisation and education/quality control programs is recommended with observation of patient and economic outcomes.