Abstract
Since the first proposal outlining the role of the advance cardiac sonographer (ACS) in 2009, 1 the use of this role has evolved into a variety of clinical practice environments. Patient care has improved through the ACS framework of performing exams at an advanced level, mentoring others, implementing quality assurance, and involvement in research. Although these tenets have had little change, the manner in which the ACS is used has become even more varied. Some ACSs provide daily oversight of junior sonographer performance, while others are focused on education and accreditation, and other ACS positions are primarily in advanced imaging, during structural heart intra-procedural environments.
The ACS provides a mechanism for hiring personnel with validated advanced competency not only in cardiac sonography but with a comprehensive understanding of the application of multi-modality imaging, advanced imaging techniques (eg, 3D, strain, perfusion), and a wide range of cardiovascular hemodynamic, pharmacology, and disease understanding.
Overall this important role represents a set of competencies (ie, verified by the passing of the Cardiovascular Credentialing International credentialing exam) for performance of cardiac sonography at an advanced level with job responsibilities that impact laboratory workflow and the quality of patient care.
The Importance and Job Responsibilities
One of the greatest impacts to patient care, by implementing an ACS position, is the focus on quality, education, and improvement. Studies indicate that quality improvement through monitoring of echocardiographic parameters with individual feedback and education improves reproducibility and decreases reader variability, among sonographers and physicians. 2 Many work environments that utilize an ACS often provide mentorship, education, and feedback.
Aiding in maintaining laboratory accreditation, is an additional role for the ACS, which further enhances examination quality. Accredited echocardiography laboratories have been shown to have more complete reporting and better image quality compared to non-accredited laboratories. 3 Additionally improvement in reader concordance, accuracy, and reproducibility impacts the accuracy of evaluating patients, with valvular heart disease. Having sonographers with advanced training may improve reporting efficiency while retaining senior sonographers by providing additional career opportunities. 4
The ACS’s Impact on Workflow
The ACS has many benefits to patient care, patient flow, and laboratory management. Having an ACS as a resource for everyday oversight and partnering with staff sonographers ensures that necessary images are obtained which answers the clinical question and reduces repeat testing. 5 The ACS aids in creating preliminary reporting to provide physician workflow that is more efficient with overall improved quality.
Frequently laboratory managers have financial, scheduling, leadership, problem management, and disciplinary duties that consume much of the everyday work. Sometimes education and staff mentoring can be challenging for lab managers to implement, in addition to the managerial duties. The ACS provides an alternative position dedicated to quality, mentorship, education, and ongoing performance improvement.
Pursuing a Career as an ACS
Two primary pathways remain in pursuing a career as an ACS. For those having been credentialed in the field for greater than 7 years with full-time work, they are able to take the credentialing examination. Those interested in an accelerated pathway could enroll in one of two accredited programs by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), which teach this advanced level of clinical practice.
The initial tenets of the ACS profession was based on assisting staff sonographers, reviewing studies to ensure complete preliminary reporting to the reading cardiologists, education, and quality assurance. These goals have been realized through the development and implementation of education programs and the increased utilization of the ACS. The education programs are 16 to 18 month programs providing advanced education, interpretation, and performance skills while incorporating multi-modality imaging and educational design.6,7 Completing a CAAHEP accredited ACS program and passing the credentialing exam ensures that an ACS has completed standardized education which includes an approved curricula, based on national guidelines and best practice standards.
Since programmatically accredited educational institutions have developed pathways to obtain advanced education, an advanced credential is available to validate competency and more job openings are available for advanced sonographers. The ACS holds various job titles that range from advanced cardiac sonographer, advanced clinical sonographer, and senior cardiac sonographer8,9 with current open positions having a posted starting salary over $150,000. Some institutions have openings for an ACS to serve as a top-level sonographer and often have added duties such as assisting physicians in procedure rooms, provide mentorship to students, staff, fellows, as well as implementing quality assurance programs. 10 Job descriptions include essential accountabilities outlined herein as well as having specific knowledge, skills with minimum experience, and education. 11
Conclusion
The road from conception to implementation of the ACS has been an exciting evolution. Practice variability continues among various imaging modalities and among nations worldwide. Cardiac sonographers in the United Kingdom are trained and tested on scanning and issue final reporting 12 whereas in the United States, a final report is the function of the cardiologist. We will continue to see advance practice opportunities develop as healthcare continues to change and go through times of crisis. Ensuring standardized educational curricula and the completion of national credentialing examinations will continue to support the evolution of an advanced professional.