title: Online audit and feedback improve fetal second-trimester four-chamber view images: a randomised controlled trial.
abstract: OBJECTIVE
  We aimed to study the impact of online audit and feedback on fetal four-chamber view image quality.
  
  
  METHODS
  Ultrasonographers uploaded a set of four-chamber views from 10 consecutive screening examinations and a second set 3 months later. They were randomised to receive (group A) or not (group B) a feedback for their first set. The primary outcome was the difference in image mean score and in percentage of inadequate images between the first set and the second set, comparing the groups with and without feedback.
  
  
  RESULTS
  There were 258 ultrasonographers who completed the trial (group A: 122; group B: 136), and 5160 images were audited. In both groups, the mean score increased. In group A, it rose from 17.0 to 18.5 (p < 0.0001), and in group, B from 17.6 to 18.3 (p < 0.0001). The improvement was greater in group A than in group B (1.5 vs. 0.7, p = 0.0007). The mean percentage of inadequate images decreased in both groups. In group A, it dropped from 32% to 19% (p < 0.0001), and in group B, from 26% to 21% (p = 0.012). The decrease was greater in group A than in group B (13% vs. 5%, p = 0.007).
  
  
  CONCLUSIONS
  Image quality improved following online audit, the improvement being slightly greater with feedback.
authors.affiliation: Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié Salpêtrière APHP and Université Paris 6, Paris, France; Collège Français d'Echographie Foetale, Montpellier, France.
authors.forename: Suha
authors.initials: S
authors.lastname: Jaudi
authors.forename: Benjamin
authors.initials: B
authors.lastname: Granger
authors.forename: Claire Nguyen
authors.initials: CN
authors.lastname: Herpin
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fries
authors.forename: Sophie Tezenas
authors.initials: ST
authors.lastname: Du Montcel
authors.forename: Marc
authors.initials: M
authors.lastname: Dommergues
mesh_terms: D002983:Clinical Competence / Q000592:standards; D005246:Feedback; D005260:Female; D005602:France; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008880:Midwifery; D009862:Online Systems; D010820:Physicians; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D058996:Quality Improvement; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000592:standards*