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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
Reducing Unnecessary Imaging in Children With Multicystic Dysplastic Kidney or Solitary Kidney
Natasha A Jawa1,2, Norman D Rosenblum3,4,5, Seetha Radhakrishnan3,5
1Division of Nephrology and natasha.jawa@sickkids.ca.
Insights
A new algorithm significantly reduced unnecessary ultrasounds in children with multicystic dysplastic kidney (MCDK) or congenital solitary kidney (CSK). This initiative improves care quality and saves healthcare costs by standardizing renal ultrasound frequency.
Area of Science:
- Pediatric Nephrology
- Medical Imaging
- Healthcare Quality Improvement
Background:
- Children with isolated unilateral multicystic dysplastic kidney (MCDK) or congenital solitary kidney (CSK) often undergo serial renal ultrasonography.
- Evidence suggests that frequent ultrasounds in this population offer limited benefits and lead to overuse of resources and increased healthcare expenditures.
- There is a need to optimize ultrasound protocols to improve care quality and reduce unnecessary medical interventions.
Purpose of the Study:
- To evaluate the impact of a clinical decision-making algorithm on reducing avoidable ultrasounds in pediatric patients with MCDK or CSK.
- To standardize the frequency of renal ultrasonography based on evidence-based guidelines.
- To improve the quality of care and reduce healthcare costs associated with unnecessary imaging.
Main Methods:
- A single-center, prospective, interrupted time series study was conducted on children under 18 with confirmed isolated unilateral MCDK or CSK.
- A consensus, evidence-based decision-making algorithm for managing pediatric MCDK or CSK was developed and refined.
- The algorithm standardized ultrasound frequency to specific intervals: post-birth, 6 months, 2, 5, 10, and 15 years.
Main Results:
- The implementation of the algorithm led to a 47% reduction in the proportion of avoidable ultrasounds ordered for children with MCDK and CSK (P < .001).
- This reduction in unnecessary ultrasounds was sustained over a 6-month period.
- The initiative is projected to result in annual savings of at least $46,000.
Conclusions:
- A clinical decision-making algorithm effectively reduced the frequency of avoidable ultrasound testing in children with MCDK and CSK.
- Further improvements in provider adherence to the algorithm could lead to even greater reductions in unnecessary ultrasounds.
- The study highlights the potential for evidence-based protocols to enhance healthcare quality and efficiency in pediatric nephrology.
Background And Objectives:
Children with isolated unilateral multicystic dysplastic kidney (MCDK) or congenital solitary kidney (CSK) undergo serial renal ultrasonography with variable frequency until they are transitioned to adult care. A growing body of literature suggests the value of frequent ultrasonography in this population is limited, providing no benefit to overall outcomes. Despite emerging evidence, ultrasound remains overused, resulting in avoidable health care expenditures and unnecessary use of resources. With our initiative, we aimed to improve quality of care by reducing avoidable ultrasounds in these children.
Methods:
This was a single-center, prospective, interrupted time series of children <18 years with ultrasound-confirmed isolated unilateral MCDK or CSK in the outpatient nephrology clinic to evaluate the effect of a decision-making algorithm on the proportion of children receiving an avoidable ultrasound. An algorithm depicting a consensus, evidence-based protocol for managing pediatric MCDK or CSK was refined through content expert feedback and usability testing to standardize frequency of ultrasonography. Ultrasounds were deemed necessary after birth, at 6 months, and at 2, 5, 10, and 15 years. Differences pre- and postintervention were determined by using a U chart and t and F tests for significance.
Results:
The algorithm resulted in a 47% reduction (P < .001) in the proportion of avoidable ultrasounds ordered in children with MCDK and CSK. This reduction was sustainable over a 6-month period and would result in at least $46 000 annual savings.
Conclusions:
Introduction of a clinical decision-making algorithm was associated with a reduction in avoidable ultrasound testing. Improving adherence across providers may allow for an even more pronounced reduction.
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