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Introduction Left ventricular ejection fraction (LVEF) is an important parameter for assessing left ventricular function on an echocardiogram. Precision and reproducibility are essential for directing management, especially in patients requiring serial echocardiograms. Skills vary depending on operator experience, and inter-operator variability may lead to inconsistencies if multiple readers are assessing the LVEF in subsequent exams. A discrepancy in LVEF assessments has been noted locally in the department, prompting us to conduct a quality improvement (QI) project to mitigate this.Method A quality improvement (QI) project was conducted utilising the Plan-Do-Study-Act (PDSA) methodology. During the initial cycle, four cases of echocardiograms (including apical four-chamber and apical two-chamber views) were presented to a cohort of 16 cardiac physiologists for the assessment of left ventricular ejection fraction (LVEF) using Simpson's biplane method. The collected data were analysed to calculate mean values, variability, and standard deviations, with the results depicted using whisker and bar plots. Subsequently, participants received a structured educational intervention, comprising a tutorial review of reference cases and LVEF calculation techniques. Additionally, a buddy system was implemented, pairing each participant with a senior staff member to collaboratively review and assess LVEF on two scans per day. After six months, a second PDSA cycle was conducted, wherein participants were reassessed using the same methodology, this time with five echocardiographic cases.Results During the initial cycle, inter-operator variability in the assessment of left ventricular ejection fraction (LVEF) ranged from 9% to 22%, as illustrated in the whisker and bar plot in figure 1. The maximum standard deviation observed was 5.6 relative to the mean value. Notably, senior staff members demonstrated lower variability in LVEF assessment, with inter-operator variability measured at 6%. Following the intervention, a marked reduction in inter-operator variability was observed across all staff groups, irrespective of seniority, with variability ranging between 3% and 6% (figure 2). Additionally, the standard deviation showed significant improvement, decreasing to 2.0 relative to the mean value.Abstract 6-002 Figure 1Whisker and bar plot demonstrating the inter-operator variability in the first cycleAbstract 6-002 Figure 2Whisker and bar plot demonstrating inter-operator variability in second cycle post interventionConclusion Inter-operator variability in LVEF assessments can pose a significant risk to patients especially whilst making decisions regarding life-saving treatment such as device therapy. This QIP implemented at our cardiac department demonstrated a strategy of regular teaching sessions using the PDSA approach and interventions such as buddy systems to mitigate this risk.