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. 2022 Nov 28;9(12):1845.
doi: 10.3390/children9121845.

Quality Improvement in a Pediatric Echocardiography Laboratory: A Collaborative Process

Danielle Sganga  1 , Sarina Behera  2 , Meaghan J Beattie  2 , Katie Jo Stauffer  2 , Aubrey Burlinson  2 , Leo Lopez  2 , Elif Seda Selamet Tierney  2
Affiliations

Quality Improvement in a Pediatric Echocardiography Laboratory: A Collaborative Process

Danielle Sganga et al. Children (Basel). .

Abstract

Transthoracic echocardiography (TTE) is an essential tool for diagnosis and management of congenital heart disease. Pediatric echocardiography presents unique challenges including complex anatomy, variable patient cooperation and provider expertise. Diagnostic errors inevitably occur. We designed a collaborative and stepwise quality improvement (QI) process to address diagnostic errors within our laboratory. We retrospectively reviewed medical records to identify diagnostic TTE errors in 100 consecutive cardiac surgery patients ≤ 5 years old (July 2020-January 2021). We identified 18 diagnostic errors. Most errors had minor impact (14/18), and 13 were preventable or possibly preventable. We presented these results to our sonographers and faculty and requested input on preventing and managing diagnostic errors. Our root cause analysis based on their responses yielded 7 areas for improvement (imaging, reporting, systems, time, environment, people, QI processes). Our faculty and sonographers chose QI processes and imaging as initial areas for intervention. We defined our SMART goal as a 10% reduction in diagnostic errors. We implemented interventions focused on QI processes. On initial follow up in May 2022, we identified 7 errors in 70 patients (44% reduction in error rate). Utilizing a stepwise and team-based approach, we successfully developed QI initiatives in our echocardiography laboratory. This approach can serve as a model for a collaborative QI process in other institutions.

Keywords: congenital heart disease; diagnostic errors; pediatric echocardiography laboratory; quality improvement.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The quality improvement process. QI is both iterative and cyclical.
Figure 2
Figure 2
Fishbone diagram. This diagram depicts faculty and sonographer fellow responses, analyzed and grouped into seven categories that may contribute to diagnostic TTE errors.
Figure 3
Figure 3
Pareto diagram depicting cardiology faculty and sonographer input on how to prioritize areas for QI intervention to address diagnostic TTE errors.
See this image and copyright information in PMC

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