Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
J Pediatr Surg. 2022 Nov;57(11):582-588. doi: 10.1016/j.jpedsurg.2021.11.026. Epub 2021 Dec 5.
Despite ongoing efforts to decrease ionizing radiation exposure from computed tomography (CT) use in pediatric appendicitis, high CT utilization rates are still observed across many hospitals. This study aims to identify factors influencing CT use and facilitators and barriers to quality improvement efforts.
The Pediatric Surgery Quality Collaborative is a voluntary consortium of 42 children's hospitals participating in the National Surgical Quality Improvement Project - Pediatric. Hospitals were compared based on CT utilization from January 1, 2019, to December 31, 2019. Semi-structured interviews were conducted with surgeons, radiologists, emergency medicine physicians, and clinical data abstractors from 7 hospitals with low CT use rates (high performers) and 6 hospitals with high CT use rates (low performers). A mixed deductive and inductive coding approach for analysis of the interview transcripts was used to develop a codebook based on the Theoretical Domains Framework and subsequently identify prominent barriers and facilitators to CT reduction.
Thematic saturation was achieved after 13 interviews. We identified four factors that distinguish high-performing from low-performing hospitals: (1) consistent availability of resources such as ultrasound technicians, pediatric radiologists, and magnetic resonance imaging (MRI); (2) presence of and adherence to protocols guiding imaging modality decision making and imaging execution; (3) culture of inter-departmental collaboration; and (4) presence of a radiation reduction champion.
Significant barriers to reducing the use of CT in pediatric appendicitis exist. Our findings highlight that future quality improvement efforts should target resource availability, protocol adherence, collaborative culture, and radiation reduction champions.
Level III.
尽管一直在努力降低计算机断层扫描（CT）在小儿阑尾炎中的应用所带来的电离辐射暴露，但许多医院的 CT 使用率仍然很高。本研究旨在确定影响 CT 使用的因素，以及质量改进工作的促进因素和障碍。
小儿外科学术质量协作组是一个由 42 家儿童医院组成的自愿联盟，参与国家外科学术质量改进计划-小儿科。根据 2019 年 1 月 1 日至 2019 年 12 月 31 日的 CT 使用情况，对医院进行了比较。对来自 7 家 CT 使用量较低（表现较好）和 6 家 CT 使用量较高（表现较差）的医院的外科医生、放射科医生、急诊医师和临床数据提取员进行了半结构式访谈。采用理论领域框架的演绎和归纳混合编码方法，对访谈记录进行分析，根据该框架制定一个编码手册，并随后确定减少 CT 扫描的突出障碍和促进因素。
13 次访谈后达到主题饱和。我们确定了将表现较好的医院与表现较差的医院区分开来的四个因素：（1）始终有超声技师、儿科放射科医生和磁共振成像（MRI）等资源可用；（2）存在并遵守指导成像方式决策和成像执行的协议；（3）跨部门合作的文化；以及（4）有一名辐射减少的拥护者。
小儿阑尾炎中减少 CT 使用存在重大障碍。我们的研究结果强调，未来的质量改进工作应针对资源可用性、协议遵守、合作文化和辐射减少拥护者。
3 级。
