Web-Based Quality Assurance Process Drives Improvements in Obstetric Ultrasound in 5 Low- and Middle-Income Countries

Abstract

High quality is important in medical imaging, yet in many geographic areas, highly skilled sonographers are in short supply. Advances in Internet capacity along with the development of reliable portable ultrasounds have created an opportunity to provide centralized remote quality assurance (QA) for ultrasound exams performed at rural sites worldwide. We sought to harness these advances by developing a web-based tool to facilitate QA activities for newly trained sonographers who were taking part in a cluster randomized trial investigating the role of limited obstetric ultrasound to improve pregnancy outcomes in 5 low- and middle-income countries. We were challenged by connectivity issues, by country-specific needs for website usability, and by the overall need for a high-throughput system. After systematically addressing these needs, the resulting QA website helped drive ultrasound quality improvement across all 5 countries. It now offers the potential for adoption by future ultrasound- or imaging-based global health initiatives.

FIGURE 1

Diagram of the Web-Based Obstetric Ultrasound Quality Assurance Process in 5 Low- and Middle-Income Countries^a Abbreviation: QA, quality assurance. ^a Democratic Republic of the Congo, Guatemala, Kenya, Pakistan, and Zambia.

FIGURE 2

Screen Shot of the Evaluation Checklist From the Ultrasound Quality Assurance Website The reviewer's simple checklist is on the left with radio buttons to indicate either "yes" for high quality, "no" for poor quality, or "NA" (not applicable). Below, there is room for comments, a drop-down menu for the final evaluation decision, and a checkbox to indicate potential as a teaching case. The images are on the right, with easy-to-navigate scrollable thumbnail images below the selected image.