Hahn Eunice, Taylor Michael, Duncan Nikki, Statile Angela, Brown James, Hill Garick, Statile Christopher
The Heart Institute, Cincinnati Children's Hospital Medical Center; and.
Department of Pediatrics, Cincinnati Children's Hospital Medical Center.
Pediatr Qual Saf. 2020 Dec 28;6(1):e380. doi: 10.1097/pq9.0000000000000380. eCollection 2021 Jan-Feb.
In echocardiography, the Doppler principle allows the measurement of tissue velocities. Using the Bernoulli equation, velocities are translated to estimated pressure differences, which dictate the timing of cardiac interventions. Our echocardiography laboratory demonstrated variability in the Doppler interrogation of heart valves, leading to difficulties in comparison over time and study accuracy. To align with previously published quality metrics in echocardiography, our laboratory used quality improvement methodology to achieve measurable improvement in Doppler acquisition.
We developed a standardized protocol for Doppler acquisition and translated it to a 20-point scoring system. We established a baseline over 4 months via random assessment of 2 first-time, normal studies per day. Interventions included standardizing the process for acquisition, education, visual tracking, and individual feedback.
The percentage of studies with a score of 16 or higher preintervention was 17%. The median score was 13.4. In total, we analyzed 407 studies, 173 pre- and 234 postintervention. Over a 4-month intervention period, the median score improved to 18.1, with 85% of studies achieving a score of 16 or higher. Special cause variation occurred after protocol distribution, education, and feedback.
Our initiative demonstrated significant improvement in the Doppler interrogation of cardiac structures using a measurable scoring system and a concrete goal of incorporating 20 areas of Doppler assessment in normal studies. Our next step is to spread this assessment to abnormal studies, thus developing consistency in evaluating all studies throughout the laboratory.
在超声心动图检查中，多普勒原理可用于测量组织速度。利用伯努利方程，速度可转化为估计的压力差，这决定了心脏介入治疗的时机。我们的超声心动图实验室发现，心脏瓣膜多普勒检查存在变异性，导致随时间推移进行比较和研究准确性方面存在困难。为了符合先前发表的超声心动图质量指标，我们的实验室采用质量改进方法，以在多普勒采集方面实现可测量的改进。
我们制定了多普勒采集的标准化方案，并将其转化为一个20分的评分系统。我们通过每天随机评估2例首次正常研究，在4个月内建立了基线。干预措施包括规范采集过程、开展培训、进行视觉跟踪以及提供个人反馈。
干预前得分为16分或更高的研究比例为17%。中位数得分为13.4。我们总共分析了407项研究，其中干预前173项，干预后234项。在为期4个月的干预期内，中位数得分提高到18.1，85%的研究得分达到16分或更高。在方案分发、培训和反馈之后出现了特殊原因变异。
我们的举措表明，使用可测量的评分系统以及在正常研究中纳入20个多普勒评估领域的具体目标，心脏结构的多普勒检查有了显著改进。我们的下一步是将这种评估扩展到异常研究，从而在整个实验室评估所有研究时实现一致性。
