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J Am Soc Echocardiogr. 2016 Dec;29(12):1163-1170.e3. doi: 10.1016/j.echo.2016.09.002. Epub 2016 Oct 11.

Implementation of a Quality Improvement Bundle Improves Echocardiographic Imaging after Congenital Heart Surgery in Children.

Author information

1
Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, Kansas City, Missouri. Electronic address: aparthiban@cmh.edu.
2
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
3
Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts.
4
Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.
5
Department of Biostatistics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri.

Abstract

BACKGROUND:

Postoperative echocardiography after congenital heart disease surgery is of prognostic importance, but variable image quality is problematic. We implemented a quality improvement bundle comprising of focused imaging protocols, procedural sedation, and sonographer education to improve the rate of optimal imaging (OI).

METHODS:

Predischarge echocardiograms were evaluated in 116 children (median age, 0.51 years; range, 0.01-5.6 years) from two centers after tetralogy of Fallot repair, arterial switch operation, and bidirectional Glenn and Fontan procedures. OI rates were compared between the centers before and after the implementation of a quality improvement bundle at center 1, with center 2 serving as the comparator. Echocardiographic images were independently scored by a single reader from each center, blinded to center and time period. For each echocardiographic variable, quality score was assigned as 0 (not imaged or suboptimally imaged) or 1 (optimally imaged); structures were classified as intra- or extracardiac. The rate of OI was calculated for each variable as the percentage of patients assigned a score of 1.

RESULTS:

Intracardiac structures had higher OI than extracardiac structures (81% vs 57%; adjusted odds ratio [OR], 3.47; P < .01). Center 1 improved overall OI from 48% to 73% (OR, 4.44; P < .01), intracardiac OI from 69% to 85% (OR, 3.53; P = .01), and extracardiac OI from 35% to 67% (OR, 5.16; P < .01). There was no temporal difference for center 2.

CONCLUSIONS:

After congenital heart disease surgery in children, intracardiac structures are imaged more optimally than extracardiac structures. Focused imaging protocols, patient sedation, and sonographer education can improve OI rates.

KEYWORDS:

Congenital heart disease; Echocardiography; Image quality; Pediatric; Postoperative; Quality improvement

PMID:
27742240
DOI:
10.1016/j.echo.2016.09.002
[Indexed for MEDLINE]

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