Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA.
Department of Radiology, Children's Health, 1935 Medical District Dr, Dallas, TX, 75235, USA.
Emerg Radiol. 2023 Apr;30(2):161-166. doi: 10.1007/s10140-022-02106-5. Epub 2023 Jan 4.
Ultrasound of the right lower quadrant for appendicitis requires specific training and practice. Improved visualization of the appendix can result in decreased utilization of computed tomography. Increasing the sensitivity of ultrasound for appendicitis thus decreases radiation exposure, reduces cost, and improves the patient healthcare experience in accordance with the three principles of the triple aim designated by the Institute for Healthcare Improvement. The purpose of this study was to examine the effect of a structured training program supplemented by technologist feedback on sonographic visualization of the appendix in a large pediatric health system.
The baseline ultrasound visualization frequency was computed for 20 ultrasound technologists in a large pediatric health system. Following this, technologists were informed of their individual and relative performance. Those with visualization frequencies less than 75% were provided structured training by a designated sonographer with an appendix visualization frequency above 75% while those with greater than 75% visualization continued to be monitored and informed of their monthly frequency. Following this structured training, appendix visualization frequencies were monitored over the next 5 months.
There was no significant effect of sonographer career experience on the baseline appendix visualization frequency. Fourteen of 20 technologists demonstrated improved visualization frequencies post-intervention. The composite visualization frequency among these 20 technologists improved from 66.55 to 69.14%. This resulted in a potential savings of 38 CT scans during the post-intervention period.
An appendix visualization rate monitoring program coupled with structured training was successful in improving the appendix visualization rate throughout a large pediatric health system. This program demonstrates the positive effect that monitoring and targeted intervention can have on a quality improvement program. The program continues to be carried out as part of a plan-study-do-act cycle.
针对阑尾炎的右下象限超声检查需要特定的培训和实践。提高阑尾的可视化程度可以减少计算机断层扫描的使用。提高超声对阑尾炎的敏感性可以降低辐射暴露，降低成本，并根据改善医疗保健研究所指定的三重目标的三个原则改善患者的医疗体验。本研究旨在检查在大型儿科保健系统中，补充技术员反馈的结构化培训计划对阑尾超声可视化的影响。
计算了大型儿科保健系统中 20 名超声技术员的基线超声可视化频率。在此之后，告知技术员他们的个人和相对表现。那些可视化频率低于 75%的人由一位指定的超声技师提供结构化培训，该技师的可视化频率高于 75%，而那些可视化频率高于 75%的人继续受到监测，并告知其每月的频率。在接受这种结构化培训后，接下来的 5 个月监测了阑尾的可视化频率。
超声技师的职业经验对基线阑尾可视化频率没有显著影响。20 名技术员中有 14 名在干预后显示出可视化频率的提高。这 20 名技术员的综合可视化频率从 66.55%提高到 69.14%。这导致在干预后期间潜在节省了 38 次 CT 扫描。
结合结构化培训的阑尾可视化率监测计划成功地提高了整个大型儿科保健系统的阑尾可视化率。该计划展示了监测和有针对性的干预对质量改进计划的积极影响。该计划继续作为计划-研究-行动循环的一部分进行。
