Improving pediatric sonographer visualization of the superior mesenteric vasculature: A local quality improvement...

Ultrasound is emerging as a viable first-line imaging modality in the assessment of midgut volvulus. However, successful transition to this technique can be challenging.

The aim of our project was to increase sonographer visualization rates of the superior mesenteric artery and superior mesenteric vein (SMA/SMV) by >39 % from baseline over a 7-month period.

We conducted a quality improvement project targeting the ultrasound department at a large academic children's hospital system. The study included 615 patients who underwent pyloric or volvulus ultrasounds. Interventions included implementation of a team goal, monthly review of deficient exams and radiologist to sonographer peer review. Our primary outcome measure was percentage of exams in which the SMA/SMV vascular pedicle was successfully visualized.

The average baseline rate of SMA/SMV visualization was 37 %. This rate increased to 72 % within one month of implementation, and an average of 83 % visualization was achieved over the 7-month period of observation. This improvement was sustained during the 2 months immediately following the conclusion of the formal observation period and remained evident 2 years post-completion.

Our quality improvement initiative resulted in significant, rapid, and sustained improvement in sonographer visualization rates of the superior mesenteric vasculature. Given widespread interest in volvulus ultrasound, we provide a framework for successfully training sonographers to perform this exam. The approach we used may also have potential to be utilized in the implementation of other imaging protocols.