title: Using Improvement Methodology to Optimize Echocardiographic Imaging of Coronary Arteries in Children.
abstract: BACKGROUND
  According to the American Society of Echocardiography, coronary artery (CA) imaging is recommended in pediatric examinations to identify CA anomalies. A review of the authors' center's echocardiographic studies revealed that CA images were often nondiagnostic. The aim of this study was to utilize quality improvement methodology to increase the percentage of first-time pediatric studies with definitive CA identification from a baseline of 45% to a goal of at least 75% in 9 months.
  
  
  METHODS
  A scoring system was developed to characterize the completeness of CA imaging. One point was scored for demonstration of each of the following: right CA origin by two-dimensional imaging, right CA origin by color flow Doppler imaging, left CA origin by two-dimensional imaging, and left CA origin by color flow Doppler imaging. A score of 4 was considered to represent definitive imaging. A baseline was obtained on 100 first-time echocardiograms with normal findings. During the intervention, 10 randomly selected first-time studies with normal findings were scored weekly for assessment of CA imaging. Interventions were focused on the following domains: excellence in image quality, shared ownership, transparency, and effective communication. Key interventions included labeling CA images, requiring two-dimensional and color Doppler images, optimization of settings, and elimination of macros for CA reporting.
  
  
  RESULTS
  The percentage of definitive CA identification increased from 45% to 82.5% over 4 months and was sustained for 7 months. Accurate reporting of incomplete CA imaging increased from 17% to 77.5%.
  
  
  CONCLUSIONS
  Improved pediatric CA imaging and reporting were achieved through the implementation of key interventions.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: christopher.statile@cchmc.org.
authors.forename: Christopher
authors.initials: C
authors.lastname: Statile
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Angela
authors.initials: A
authors.lastname: Statile
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: James
authors.initials: J
authors.lastname: Brown
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Samuel
authors.initials: S
authors.lastname: Hanke
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Michael
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Erik
authors.initials: E
authors.lastname: Michelfelder
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002309:Cardiology / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging*; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging*; D018618:Echocardiography, Doppler, Color / Q000592:standards*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000592:standards*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009820:Ohio; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Coronary artery imaging; Echocardiography; Pediatrics; Quality improvement