Quality improvement programme of ultrasound based fetal anatomy screening using large scale clinical audit
<strong>OBJECTIVE:</strong>Large scale audit and peer review of ultrasound images is advantageous, but is rarely performed consistently as it is time-consuming and expensive. Here we investigate the effect of large scale audit of routine fetal anatomy scans to assess if a full clinical a...
| Main Authors: | , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
Wiley
2018
|
| _version_ | 1797072200690302976 |
|---|---|
| author | Yaqub, M Kelly, B Stobart, H Napolitano, R Noble, J Papageorghiou, A |
| author_facet | Yaqub, M Kelly, B Stobart, H Napolitano, R Noble, J Papageorghiou, A |
| author_sort | Yaqub, M |
| collection | OXFORD |
| description | <strong>OBJECTIVE:</strong>Large scale audit and peer review of ultrasound images is advantageous, but is rarely performed consistently as it is time-consuming and expensive. Here we investigate the effect of large scale audit of routine fetal anatomy scans to assess if a full clinical audit cycle could improve clinical image acquisition standards. <strong>METHODS:</strong>A large scale, clinical, retrospective audit was conducted of ultrasound images from all routine anomaly scans undertaken in a UK hospital (from 18 weeks + 0 days to 22 weeks + 6 days) for one calendar year, to build a baseline understanding of the performance of sonographers. Targeted actions were undertaken in response to the findings with the aim of improving departmental performance. A second full year audit was then performed. An independent pool of sonographers used an online tool to assess all scans in two ways: scan completeness (i.e. were all images archived?) and image quality using objective scoring (i.e. were images of high quality?). Both were assessed at departmental level and at individual sonographer level. A 10% random sample of scans was used to assess inter-observer reproducibility. <strong> RESULTS:</strong>Images (n=103,501) from 6,257 anomaly scan examinations undertaken by 22 sonographers were assessed in cycle 1 of the audit; in cycle 2, 153,557 images from 6,406 scans undertaken by 25 sonographers were evaluated. The analysis was performed on the 20 sonographers participating in both cycles. Departmental median scan completeness improved from 72% in the first year to 78% at the second assessment (p<0.001); median image quality score across all fetal views improved from 0.83 to 0.86 (p<0.001). The improvement was greatest for those sonographers who were performing poorest on the first audit: the 14% of poorest performing sonographers showed more than 30% improvement in scan completeness; and 11% showed more than 10% improvement in image quality. Inter-observer repeatability of scan completeness and image quality scores across different fetal views were similar to the published literature. <strong>CONCLUSION:</strong>Clinical audit and a set of targeted actions helped improve sonographer scan acquisition completeness and scan quality. Such adherence to recommended clinical acquisition standards may increase the likelihood of correct measurement and thereby fetal growth assessment; and should allow better detection of abnormalities. As such large-scale audit is time consuming, further advantages would be achieved if this process could be automated. |
| first_indexed | 2024-03-06T23:04:17Z |
| format | Journal article |
| id | oxford-uuid:63405ac9-f065-464d-8adc-e28495df6622 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T23:04:17Z |
| publishDate | 2018 |
| publisher | Wiley |
| record_format | dspace |
| spelling | oxford-uuid:63405ac9-f065-464d-8adc-e28495df66222022-03-26T18:11:38ZQuality improvement programme of ultrasound based fetal anatomy screening using large scale clinical auditJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:63405ac9-f065-464d-8adc-e28495df6622EnglishSymplectic Elements at OxfordWiley2018Yaqub, MKelly, BStobart, HNapolitano, RNoble, JPapageorghiou, A<strong>OBJECTIVE:</strong>Large scale audit and peer review of ultrasound images is advantageous, but is rarely performed consistently as it is time-consuming and expensive. Here we investigate the effect of large scale audit of routine fetal anatomy scans to assess if a full clinical audit cycle could improve clinical image acquisition standards. <strong>METHODS:</strong>A large scale, clinical, retrospective audit was conducted of ultrasound images from all routine anomaly scans undertaken in a UK hospital (from 18 weeks + 0 days to 22 weeks + 6 days) for one calendar year, to build a baseline understanding of the performance of sonographers. Targeted actions were undertaken in response to the findings with the aim of improving departmental performance. A second full year audit was then performed. An independent pool of sonographers used an online tool to assess all scans in two ways: scan completeness (i.e. were all images archived?) and image quality using objective scoring (i.e. were images of high quality?). Both were assessed at departmental level and at individual sonographer level. A 10% random sample of scans was used to assess inter-observer reproducibility. <strong> RESULTS:</strong>Images (n=103,501) from 6,257 anomaly scan examinations undertaken by 22 sonographers were assessed in cycle 1 of the audit; in cycle 2, 153,557 images from 6,406 scans undertaken by 25 sonographers were evaluated. The analysis was performed on the 20 sonographers participating in both cycles. Departmental median scan completeness improved from 72% in the first year to 78% at the second assessment (p<0.001); median image quality score across all fetal views improved from 0.83 to 0.86 (p<0.001). The improvement was greatest for those sonographers who were performing poorest on the first audit: the 14% of poorest performing sonographers showed more than 30% improvement in scan completeness; and 11% showed more than 10% improvement in image quality. Inter-observer repeatability of scan completeness and image quality scores across different fetal views were similar to the published literature. <strong>CONCLUSION:</strong>Clinical audit and a set of targeted actions helped improve sonographer scan acquisition completeness and scan quality. Such adherence to recommended clinical acquisition standards may increase the likelihood of correct measurement and thereby fetal growth assessment; and should allow better detection of abnormalities. As such large-scale audit is time consuming, further advantages would be achieved if this process could be automated. |
| spellingShingle | Yaqub, M Kelly, B Stobart, H Napolitano, R Noble, J Papageorghiou, A Quality improvement programme of ultrasound based fetal anatomy screening using large scale clinical audit |
| title | Quality improvement programme of ultrasound based fetal anatomy screening using large scale clinical audit |
| title_full | Quality improvement programme of ultrasound based fetal anatomy screening using large scale clinical audit |
| title_fullStr | Quality improvement programme of ultrasound based fetal anatomy screening using large scale clinical audit |
| title_full_unstemmed | Quality improvement programme of ultrasound based fetal anatomy screening using large scale clinical audit |
| title_short | Quality improvement programme of ultrasound based fetal anatomy screening using large scale clinical audit |
| title_sort | quality improvement programme of ultrasound based fetal anatomy screening using large scale clinical audit |
| work_keys_str_mv | AT yaqubm qualityimprovementprogrammeofultrasoundbasedfetalanatomyscreeningusinglargescaleclinicalaudit AT kellyb qualityimprovementprogrammeofultrasoundbasedfetalanatomyscreeningusinglargescaleclinicalaudit AT stobarth qualityimprovementprogrammeofultrasoundbasedfetalanatomyscreeningusinglargescaleclinicalaudit AT napolitanor qualityimprovementprogrammeofultrasoundbasedfetalanatomyscreeningusinglargescaleclinicalaudit AT noblej qualityimprovementprogrammeofultrasoundbasedfetalanatomyscreeningusinglargescaleclinicalaudit AT papageorghioua qualityimprovementprogrammeofultrasoundbasedfetalanatomyscreeningusinglargescaleclinicalaudit |