Abstract 14665: Using Improvement Methodology to Optimize Echocardiographic Imaging of Coronary Arteries in Children
Purpose/Objectives: Coronary artery (CA) imaging is a recommended element of pediatric echocardiographic examinations according to the American Society of Echocardiography. Coronary artery imaging is important to identify CA anomalies that can place children at risk of sudden death. A baseline review of our center’s studies revealed that CA imaging was often non-diagnostic. Using improvement methods, our aim was to increase the percentage of studies with definitive CA identification from a median of 45% to greater than 75%.
Design/Methods: A scoring system was developed to characterize completeness of CA imaging. A point was given for demonstration of each of the following: right CA origin by 2D imaging, right CA origin by color flow Doppler imaging, left CA origin by 2D imaging and left CA origin by color flow Doppler imaging. A score of 4 was considered definitive imaging. A baseline of 100 echocardiograms was reviewed prior to any process improvement intervention. Ten randomly selected, normal first time studies were subsequently evaluated weekly for quality of CA imaging.
A multidisciplinary team collaborated to develop a standardized process for CA imaging. Interventions focused in the following domains: situational awareness, attention to detail, excellence in image quality and effective communication. Select key interventions included: labeling of CA images within studies, designation of required 2D and color Doppler images, optimization of machine settings for CA imaging, and elimination of standardized macros for CA reporting.
Results: The percentage of definitive CA identification on echocardiography was increased from a median of 45% to 80% over 5 months and sustained for 4 months (Figure 1). Accurate reporting of incomplete coronary artery imaging increased from 17% at baseline to 80%.
Conclusions: Improved CA imaging and accurate reporting was achieved through the implementation of key interventions using quality improvement methods.
- © 2013 by American Heart Association, Inc.