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Implementation of a Quality Improvement Bundle Improves Echocardiographic Imaging after Congenital Heart Surgery in
Anitha Parthiban1, Jami C Levine2, Meena Nathan3
1Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
Insights
Improving echocardiogram quality after pediatric congenital heart surgery is crucial. A quality improvement bundle significantly increased optimal imaging rates for intracardiac and extracardiac structures.
Area of Science:
- Pediatric Cardiology
- Medical Imaging Quality Improvement
- Congenital Heart Surgery
Background:
- Postoperative echocardiography is vital for prognostication in children with congenital heart disease (CHD).
- Variable image quality in echocardiograms poses a significant challenge.
- A quality improvement (QI) bundle was implemented to address this issue.
Purpose of the Study:
- To assess the impact of a QI bundle on the rate of optimal imaging (OI) in postoperative echocardiograms of children undergoing CHD surgery.
- To compare OI rates between two centers before and after QI bundle implementation.
Main Methods:
- A QI bundle including focused imaging protocols, procedural sedation, and sonographer education was introduced at one center.
- Predischarge echocardiograms from 116 children post-CHD surgery were evaluated.
- Images were scored for optimal imaging of intra- and extracardiac structures; OI rates were compared between centers and time periods.
Main Results:
- Intracardiac structures had higher OI rates (81%) compared to extracardiac structures (57%).
- The QI bundle implementation at center 1 significantly improved overall OI from 48% to 73%.
- Specific improvements were noted in both intracardiac (69% to 85%) and extracardiac (35% to 67%) OI rates at center 1, with no significant change at the comparator center.
Conclusions:
- Intracardiac structures are more consistently imaged optimally than extracardiac structures after pediatric CHD surgery.
- Focused imaging protocols, procedural sedation, and sonographer education are effective strategies to enhance echocardiographic imaging quality in this population.
Background:
Postoperative echocardiography after congenital heart disease surgery is of prognostic importance, but variable image quality is problematic. We implemented a quality improvement bundle comprising of focused imaging protocols, procedural sedation, and sonographer education to improve the rate of optimal imaging (OI).
Methods:
Predischarge echocardiograms were evaluated in 116 children (median age, 0.51 years; range, 0.01-5.6 years) from two centers after tetralogy of Fallot repair, arterial switch operation, and bidirectional Glenn and Fontan procedures. OI rates were compared between the centers before and after the implementation of a quality improvement bundle at center 1, with center 2 serving as the comparator. Echocardiographic images were independently scored by a single reader from each center, blinded to center and time period. For each echocardiographic variable, quality score was assigned as 0 (not imaged or suboptimally imaged) or 1 (optimally imaged); structures were classified as intra- or extracardiac. The rate of OI was calculated for each variable as the percentage of patients assigned a score of 1.
Results:
Intracardiac structures had higher OI than extracardiac structures (81% vs 57%; adjusted odds ratio [OR], 3.47; P < .01). Center 1 improved overall OI from 48% to 73% (OR, 4.44; P < .01), intracardiac OI from 69% to 85% (OR, 3.53; P = .01), and extracardiac OI from 35% to 67% (OR, 5.16; P < .01). There was no temporal difference for center 2.
Conclusions:
After congenital heart disease surgery in children, intracardiac structures are imaged more optimally than extracardiac structures. Focused imaging protocols, patient sedation, and sonographer education can improve OI rates.
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