Improving After-Hours Echocardiography Communication: A Resident-Led Quality Improvement Project

Background  In our paediatric inpatient units, after-hours echocardiogram orders frequently lacked proper communication between ordering providers and interpreting paediatric cardiologists. This gap contributed to imaging delays, inefficiencies, and potential patient safety risks. We aimed to improve provider notification compliance for after-hours echocardiogram orders. Design  We designed a resident-led quality improvement (QI) project using sequential Plan-Do-Study-Act (PDSA) cycles. Baseline data were obtained from self-reported provider surveys. Compliance with communication was measured as the percentage of providers who self-reported "Always" notifying the on-call cardiologist at the time of order placement. Interventions included email reminders, poster reminders in work areas, and an electronic health record (EHR) modification requiring mandatory entry of indication and notification details before order completion. Three PDSA cycles were implemented over a 16-month period. Each cycle was monitored for compliance trends, with iterative adjustments based on feedback from frontline providers. Results  Baseline compliance was low, with surveys highlighting frequent lapses in provider communication. The first PDSA cycle, involving email reminders, produced a trivial improvement in compliance, while the second cycle, involving posters, further reinforced the process. The most significant and sustained improvement followed the EHR modification in the third cycle, after which communication compliance exceeded 70% and was sustained over six months. Conclusions  This resident-led project demonstrated that while simple, low-cost interventions produced modest gains, sustained improvement required an EHR-based solution, highlighting the value of combining educational and systems-level strategies to enhance patient safety.