Chui Shyr, Phinney Carly, Hansen Karina, Danskin Deanna
Medical Imaging, University Hospital of Northern British Columbia, Prince George, British Columbia, Canada
University Hospital of Northern British Columbia, Prince George, British Columbia, Canada.
BMJ Open Qual. 2025 Jan 22;14(1):e002865. doi: 10.1136/bmjoq-2024-002865.
Ultrasound is a first-line and often preferred imaging modality in the diagnosis of acute appendicitis. When the appendix is not visualised during a dedicated appendix ultrasound study, patients may require a CT study, which uses ionising radiation, or undergo conservative clinical observation with the inherent risk of clinical deterioration, perforation and sepsis. Median baseline data, at our hospital imaging department, revealed a rate of combined normal and abnormal appendix visualisation of 34.5% which is below the reported visualisation rates in the North American literature and well below the rates reported in the global literature. We embarked on a formal quality improvement (QI) project to improve the rates of appendix visualisation in our hospital ultrasound department. Using the Model of Improvement framework and a team approach, we generated and trialled multiple plan-do-study-act interventions over a project term of 12 months. In the second half of the project term, we saw a sustained rise in appendix visualisation exceeding our original stretch goal of 75% visualisation which was sustained 6 months after the formal project end (p<0.001). This rise was accompanied by a commensurate increase in sonographer confidence in appendix visualisation. In our case, the Model of Improvement methodology proved successful in solving our complex problem of sonographic appendix under-visualisation. The learnings of this QI project have been widely shared and spread according to the ethos of QI.
超声是急性阑尾炎诊断中的一线且常被首选的成像方式。在专门的阑尾超声检查中若未观察到阑尾，患者可能需要进行使用电离辐射的CT检查，或接受保守的临床观察，但存在临床病情恶化、穿孔和败血症的固有风险。我院影像科的基线数据中位数显示，阑尾正常和异常可视化的综合比率为34.5%，低于北美文献报道的可视化比率，且远低于全球文献报道的比率。我们开展了一项正式的质量改进（QI）项目，以提高我院超声科阑尾可视化的比率。我们运用改进模型框架并采用团队协作方式，在为期12个月的项目期间制定并试验了多项计划-执行-研究-行动干预措施。在项目期的后半段，我们看到阑尾可视化率持续上升，超过了我们最初设定的75%可视化的挑战性目标，并且在正式项目结束6个月后仍保持这一水平（p<0.001）。这一上升伴随着超声检查人员对阑尾可视化信心的相应提升。在我们的案例中，改进模型方法被证明成功解决了我们超声检查中阑尾可视化不足的复杂问题。根据QI的理念，这个QI项目的经验已得到广泛分享和传播。
