title: Obstetric Ultrasound Efficiency and Accuracy Using a Protocol-Based Examination.
abstract: OBJECTIVE
  Obstetric ultrasound imaging requires the acquisition of a standard set of maternal and fetal images. Our objective was to evaluate the impact of implementation of a protocol-based ultrasound examination on the duration of ultrasound examinations, examination completion, and accuracy of documentation.
  
  
  METHODS
  We conducted a case-cohort study. Obstetric ultrasound examinations performed in the first, second, and third trimesters were reviewed before and after implementation of a protocol-based ultrasound examination. The duration of the ultrasound examination, number of missing required images, and documentation of missing images were abstracted from an image archival system. To account for clustering by sonographer, 3 mixed effects models with a fixed effect for protocol and a random intercept for sonographer were used to evaluate the effect on the total time of the examination, number of missing images, and whether missing images were documented.
  
  
  RESULTS
  A total of 100 ultrasound examinations were compared: 50 before and 50 after implementation of the protocol. Statistically significant differences between outcomes before and after protocol implementation were observed for all outcomes. After implementation of the protocol, the average duration of ultrasound examinations decreased by 7.62 minutes (95% confidence interval [CI], 3.57-11.68 minutes); the number of missing images was reduced by 5.81 per examination (95% CI, 4.24-7.39); and proper documentation of missing images increased by 40.24% (95% CI, 22.77%-57.71%).
  
  
  CONCLUSIONS
  Implementation of a software protocol-based ultrasound examination significantly improved the efficiency and accuracy of obstetric ultrasound examinations in this study.
authors.affiliation: Perinatal Associates of New Mexico, Albuquerque, New Mexico USA; and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina,Chapel Hill, North Carolina USA (J.R., A.He.). mruma@panm.com.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Ruma
authors.affiliation: Perinatal Associates of New Mexico, Albuquerque, New Mexico USA; and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina,Chapel Hill, North Carolina USA (J.R., A.He.).
authors.forename: Heather
authors.initials: H
authors.lastname: Bradley
authors.affiliation: Perinatal Associates of New Mexico, Albuquerque, New Mexico USA; and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina,Chapel Hill, North Carolina USA (J.R., A.He.).
authors.forename: Anna
authors.initials: A
authors.lastname: Holstrom
authors.affiliation: Perinatal Associates of New Mexico, Albuquerque, New Mexico USA; and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina,Chapel Hill, North Carolina USA (J.R., A.He.).
authors.forename: Joseph
authors.initials: J
authors.lastname: Rigdon
authors.affiliation: Perinatal Associates of New Mexico, Albuquerque, New Mexico USA; and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina,Chapel Hill, North Carolina USA (J.R., A.He.).
authors.forename: Amy
authors.initials: A
authors.lastname: Herring
mesh_terms: D000328:Adult; D000465:Algorithms; D015331:Cohort Studies; D004282:Documentation / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D009516:New Mexico; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011873:Radiology Information Systems / Q000592:standards* / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data*
keywords: accuracy; efficiency; obstetric ultrasound; protocol; ultrasound