Chun Bennet C, Chmil Margarita, Ruess Lynne
From the Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio.
Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio.
Pediatr Qual Saf. 2023 Sep 28;8(5):e681. doi: 10.1097/pq9.0000000000000681. eCollection 2023 Sep-Oct.
Bowel management for children with chronic constipation may include repeated single-view abdomen radiographs (AXR) to monitor treatment success. Only one image of the abdomen is needed to include most of the colon, but technologists often make a second (or even third) exposure to be sure they have imaged the entire abdomen. Our quality improvement project aimed to reduce radiation exposure by decreasing the frequency of >1 exposure performed for AXR orders in children with chronic constipation from 27% to <10% by December 2022 and sustain.
We counted baseline (01/2020-11/2020) and intervention (12/2020-5/2023) examinations with >1 exposure. Initial interventions were a structured communication to technologists and an article in the monthly department newsletter and later, a technologist education module. Additional interventions included communication to radiologists, project updates and encouragement to all technologists, and individual technologist feedback. A statistical process control chart tracked data to study process changes over time.
During the baseline and intervention periods, 525/1944 and 1329/8334 examinations, respectively, had >1 exposure performed for AXR orders. Interventions created 2 centerline shifts. Overall, examinations with >1 exposure decreased from 27% to 13.5%.
Frequency of >1 exposure performed for AXR orders in children with chronic constipation decreased from 27% to 13.5% through education and communication. This was sustained. We plan to assign training modules for all new technologists, policy reminders (annual training in odd years) for all technologists, and continue individualized learning opportunities.
对于慢性便秘儿童的肠道管理可能包括反复进行单视图腹部X光片（AXR）以监测治疗效果。只需一张腹部图像就能涵盖大部分结肠，但技术人员常常会进行第二次（甚至第三次）曝光，以确保整个腹部都被成像。我们的质量改进项目旨在通过将慢性便秘儿童AXR检查中进行超过一次曝光的频率从27%降至2022年12月前的低于10%并维持该水平，来减少辐射暴露。
我们统计了基线期（2020年1月至2020年11月）和干预期（2020年12月至2023年5月）进行了超过一次曝光的检查。最初的干预措施是与技术人员进行结构化沟通以及在部门月度通讯上发表一篇文章，后来又增加了一个技术人员教育模块。其他干预措施包括与放射科医生沟通、项目更新并鼓励所有技术人员，以及向个别技术人员提供反馈。通过统计过程控制图跟踪数据，以研究随时间的过程变化。
在基线期和干预期，分别有525/1944和1329/8334次AXR检查进行了超过一次曝光。干预导致了2次中心线偏移。总体而言，进行超过一次曝光的检查从27%降至13.5%。
通过教育和沟通，慢性便秘儿童AXR检查中进行超过一次曝光的频率从27%降至13.5%，且这一水平得以维持。我们计划为所有新入职技术人员安排培训模块，为所有技术人员提供政策提醒（奇数年进行年度培训），并继续提供个性化学习机会。
