Quality-improvement program for ultrasound-based fetal anatomy screening using large-scale clinical audit.
Quality-improvement program for ultrasound-based fetal anatomy screening using large-scale clinical audit.
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DOI：
10.1002/uog.20144
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发表时间：
2019-08
期刊：
影响因子：
--
通讯作者：
Papageorghiou AT
中科院分区：
文献类型：
--
作者：
Yaqub M;Kelly B;Stobart H;Napolitano R;Noble JA;Papageorghiou AT
对超声图像进行大规模审核和同行评审可能会提高超声医师的表现，但很少能一致地进行，因为它既耗时又昂贵。本研究的目的是对常规胎儿解剖扫描进行大规模审核，以评估完整的临床审核周期是否可以提高临床图像采集标准。对 2013 年（第 1 周期）英国一家医院从妊娠 18 + 0 至 22 + 6 周期间进行的所有常规异常扫描期间获得的超声图像进行了大规模、临床、回顾性审核，以建立对超声检查人员表现的基线了解。针对调查结果，我们采取了有针对性的行动，以提高部门绩效。然后对第二年（第二周期）获得的胎儿解剖超声图像进行第二次全年审核。经验丰富的超声技师的独立池使用在线工具根据两个参数评估所有扫描：扫描完整性（即所有图像是否都存档？）和使用客观评分的图像质量（即图像是否高质量？）。两者均在部门级和超声医师个人级的每次审计中进行评估。使用 10% 扫描的随机样本来评估观察者间的再现性。在审核的第 1 周期中，评估了 22 名超声医师进行的 6257 次异常检查中的 103~501 幅超声图像；在第 2 周期中，对 25 名超声医师进行的 6406 次扫描中的 153~557 幅图像进行了评估。进行的分析包括参与两个周期的 20 名超声医师获得的图像。部门中位扫描完整性从第一年的 72% 提高到第二次评估时的 78% (P < 0.001)；所有胎儿视图的中值图像质量评分从 0.83 提高到 0.86 (P < 0.001)。对于那些在第一次审核中表现最差的超声技师来说，进步最大；在扫描完整性方面，第 1 周期中表现最差的 15% 超声检查师提高了 30% 以上，而在图像质量方面，第 1 周期中表现最差的 11% 则提高了 10% 以上。不同胎儿视图中扫描完整性和图像质量评分的观察者间重复性与已发表文献中的相似。临床审核和一系列有针对性的行动有助于提高超声医师扫描采集的完整性和扫描质量。遵守推荐的临床采集标准可能会增加正确测量的可能性，从而增加胎儿生长评估的可能性，并且应该能够更好地检测异常。由于如此大规模的审计非常耗时，如果该过程能够自动化，将会获得更多优势。 © 2018 作者。 《妇产科超声》由 John Wiley & Sons Ltd 代表国际妇产科超声学会出版。
A large‐scale audit and peer review of ultrasound images may improve sonographer performance, but is rarely performed consistently as it is time‐consuming and expensive. The aim of this study was to perform a large‐scale audit of routine fetal anatomy scans to assess if a full clinical audit cycle can improve clinical image‐acquisition standards. A large‐scale, clinical, retrospective audit was conducted of ultrasound images obtained during all routine anomaly scans performed from 18 + 0 to 22 + 6 weeks' gestation at a UK hospital during 2013 (Cycle 1), 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 of fetal anatomy ultrasound images obtained during the following year (Cycle 2). An independent pool of experienced sonographers used an online tool to assess all scans in terms of two parameters: scan completeness (i.e. were all images archived?) and image quality using objective scoring (i.e. were images of high quality?). Both were assessed in each audit at the departmental level and at the individual sonographer level. A random sample of 10% of scans was used to assess interobserver reproducibility. In Cycle 1 of the audit, 103 501 ultrasound images from 6257 anomaly examinations performed by 22 sonographers were assessed; in Cycle 2, 153 557 images from 6406 scans performed by 25 sonographers were evaluated. The analysis was performed including the images obtained by the 20 sonographers who participated 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 for all fetal views improved from 0.83 to 0.86 (P < 0.001). The improvement was greatest for those sonographers who performed poorest in the first audit; with regards to scan completeness, the poorest performing 15% of sonographers in Cycle 1 improved by more than 30 percentage points, and with regards to image quality, the poorest performing 11% in Cycle 1 showed a more than 10% improvement. Interobserver repeatability of scan completeness and image‐quality scores across different fetal views were similar to those in the published literature. A 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 a large‐scale audit is time consuming, further advantages would be achieved if this process could be automated. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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影响因子：
7.1
作者：
Salomon, LJ;Bernard, JP;Ville, Y
通讯作者：
Ville, Y
影响因子：
7.1
作者：
Napolitano, R.;Donadono, V.;Ohuma, E. O.;Knight, C. L.;Wanyonyi, S. Z.;Kemp, B.;Norris, T.;Papageorghiou, A. T.
通讯作者：
Papageorghiou, A. T.
影响因子：
3
作者：
Jaudi, Suha;Granger, Benjamin;Dommergues, Marc
通讯作者：
Dommergues, Marc
影响因子：
3
作者：
Salomon, L. J.;Winer, N.;Ville, Y.
通讯作者：
Ville, Y.
影响因子：
2.3
作者：
Chalouhi, Gihad E.;Salomon, Laurent J.;Fries, Nicolas
通讯作者：
Fries, Nicolas