Barriers and facilitators of CT scan reduction in the workup of pediatric appendicitis: A pediatric surgical quality collaborative qualitative study
Barriers and facilitators of CT scan reduction in the workup of pediatric appendicitis: A pediatric surgical quality collaborative qualitative study
复制标题
DOI：
10.1016/j.jpedsurg.2021.11.026
复制
发表时间：
2022-10-12
影响因子：
2.4
通讯作者：
Raval, Mehul, V
中科院分区：
文献类型：
--
作者：
Hu, Andrew;Chaudhury, Azraa S.;Raval, Mehul, V
引言：尽管在减少儿童阑尾炎计算机断层扫描（CT）使用中的电离辐射暴露方面不断努力，但许多医院仍观察到较高的CT使用率。本研究旨在确定影响CT使用的因素以及质量改进工作的促进因素和障碍。
方法：小儿外科质量协作组是一个由42家儿童医院组成的自愿联盟，参与了国家外科质量改进项目 - 小儿科。根据2019年1月1日至2019年12月31日的CT使用率对医院进行了比较。对来自7家CT使用率低（表现好）的医院和6家CT使用率高（表现差）的医院的外科医生、放射科医生、急诊医学医生和临床数据提取员进行了半结构化访谈。采用演绎和归纳混合编码方法对访谈记录进行分析，基于理论域框架制定了一个编码手册，随后确定了减少CT使用的主要障碍和促进因素。
结果：在13次访谈后达到了主题饱和。我们确定了区分表现好与表现差的医院的四个因素：（1）超声技师、小儿放射科医生和磁共振成像（MRI）等资源的持续可用性；（2）指导成像模式决策和成像执行的方案的存在及遵守情况；（3）跨部门合作的文化；（4）有一位减少辐射的倡导者。
结论：在儿童阑尾炎中减少CT使用存在重大障碍。我们的研究结果强调，未来的质量改进工作应针对资源可用性、方案遵守、合作文化和减少辐射的倡导者。
证据级别：III级
© 2021爱思唯尔公司。保留所有权利。
Introduction: Despite ongoing effort s to decrease ionizing radiation exposure from computed tomography (CT) use in pediatric appendicitis, high CT utilization rates are still observed across many hospitals. This study aims to identify factors influencing CT use and facilitators and barriers to quality improvement effort s.Methods: The Pediatric Surgery Quality Collaborative is a voluntary consortium of 42 children's hospitals participating in the National Surgical Quality Improvement Project -Pediatric. Hospitals were compared based on CT utilization from January 1, 2019, to December 31, 2019. Semi-structured interviews were conducted with surgeons, radiologists, emergency medicine physicians, and clinical data abstractors from 7 hospitals with low CT use rates (high performers) and 6 hospitals with high CT use rates (low perform-ers). A mixed deductive and inductive coding approach for analysis of the interview transcripts was used to develop a codebook based on the Theoretical Domains Framework and subsequently identify promi-nent barriers and facilitators to CT reduction.Results: Thematic saturation was achieved after 13 interviews. We identified four factors that distin-guish high-performing from low-performing hospitals: (1) consistent availability of resources such as ul-trasound technicians, pediatric radiologists, and magnetic resonance imaging (MRI); (2) presence of and adherence to protocols guiding imaging modality decision making and imaging execution; (3) culture of inter-departmental collaboration; and (4) presence of a radiation reduction champion.Conclusions: Significant barriers to reducing the use of CT in pediatric appendicitis exist. Our findings highlight that future quality improvement efforts should target resource availability, protocol adherence, collaborative culture, and radiation reduction champions.Levels of Evidence: Level III (c) 2021 Elsevier Inc. All rights reserved.