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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.
Insights
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.
Abstract:
Screening US for developmental dysplasia of the hip in infants with risk factors should optimally be performed after 6 weeks corrected gestational age (CGA). Scanning before this age leads to higher false-positive rates and the potential need for repeat examination, which creates waste and undue stress on the child and family. Pediatric radiologists at the authors' institution observed that many premature infants were being scheduled too early for their screening US. This quality improvement project aimed to decrease incorrectly scheduled screening examinations from a baseline rate of 50% to less than 25% within 6 months. Key drivers and interventions addressed the lack of clarity regarding whether the examination was screening or diagnostic (physical examination finding), poor visibility and manual calculation of CGA by schedulers, and lack of automated scheduling guidance. Ordering clinicians were educated, and an electronic health record (EHR) report was created to prospectively identify examinations that may need rescheduling. Next, a mandatory order question was added in the EHR to clearly identify which examinations were ordered for screening, with embedded guidance for schedulers to time these examinations after 6 weeks CGA. Finally, a special work queue was created to leverage the expertise of certain schedulers assigned to this task. After the final plan-do-study-act cycle, incorrectly scheduled examinations decreased from 50% to 10%. By using people- (specialized scheduling team), process- (dedicated work queue), and system-related (EHR order question with scheduling guidance) interventions, the group was able to create and sustain change and decreased incorrectly scheduled pediatric hip US examinations by 80%. ©RSNA, 2025.
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