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Quality Improvement Report: Decreasing Incorrectly Scheduled Screening US for Hip Dysplasia in Premature Infants
Daniella Asch1, Gowthaman Gunabushanam1, Janelle van Luling2
1Department of Radiology & Biomedical Imaging, Yale School of Medicine, 330 Cedar St, TE2, New Haven, CT 06520.
Summary
Screening ultrasounds for infant hip dysplasia are best done after 6 weeks corrected gestational age (CGA). This quality improvement project reduced incorrectly scheduled ultrasounds by 80%, improving care and reducing stress.
Area of Science:
- Pediatric Radiology
- Quality Improvement Science
- Healthcare Operations
Background:
- Screening ultrasounds for developmental dysplasia of the hip (DDH) in infants with risk factors are optimally performed after 6 weeks corrected gestational age (CGA).
- Premature infants were frequently scheduled for hip screening ultrasounds before the recommended 6-week CGA, leading to high false-positive rates and repeat examinations.
- This resulted in increased healthcare waste and undue stress for infants and families.
Purpose of the Study:
- To decrease the rate of incorrectly scheduled screening ultrasounds for DDH from a baseline of 50% to less than 25% within 6 months.
- To improve the accuracy and efficiency of scheduling pediatric hip screening ultrasounds.
- To reduce unnecessary stress and resource utilization associated with premature ultrasounds.
Main Methods:
- A quality improvement project was implemented, addressing issues of unclear order indications, manual CGA calculation, and lack of automated scheduling support.
- Interventions included clinician education, development of an electronic health record (EHR) report for identifying potentially mis-scheduled exams, and a mandatory EHR order question with scheduling guidance.
- A specialized work queue managed by trained schedulers was established to optimize the scheduling process.
Main Results:
- The rate of incorrectly scheduled screening ultrasounds decreased significantly from a baseline of 50% to 10% after project implementation.
- This represents an 80% reduction in incorrectly scheduled pediatric hip ultrasounds.
- The interventions successfully created and sustained positive change in the scheduling process.
Conclusions:
- A multi-faceted approach combining people, process, and system interventions effectively reduced incorrectly scheduled pediatric hip ultrasounds.
- Implementing standardized electronic health record guidance and specialized scheduling teams optimizes the timing of screening ultrasounds for infant hip dysplasia.
- This quality improvement initiative enhanced patient care by ensuring timely and appropriate screening examinations.
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