title: The Effect of Image Review before Patient Discharge on Study Completeness and Sonographer Job Satisfaction in a Pediatric Echocardiographic Laboratory.
abstract: Incomplete echocardiographic assessment accounts for approximately 10% of preventable diagnostic errors and may place children at risk for adverse outcomes or increased testing. The aim of this study was to determine if physician review of images improves study completeness.
  
  
  
  A prospective quality improvement (QI) study initiated physician review of first-time echocardiographic studies for completeness before patient discharge. Studies were incomplete if not all anatomic structures were diagnostically demonstrated. QI examinations were compared with controls obtained before study initiation. Demographic and clinical information and duration of scan were collected during the control and QI periods. An anonymous survey was administered to the sonographers to assess perceptions of the intervention.
  
  
  
  There were no differences between the QI (n = 63) and control (n = 63) groups in age, height, weight, and technical barriers. After study completion, 35% of control scans versus 5% of QI scans were incomplete (P < .001). In the QI group, the sonographer, physician, or both returned to scan in 12 (19%), nine (14%), and two (3%) studies, respectively. QI studies were longer than control studies (44 vs 36 min, P = .003) before review. Physician review added a median of 6 min (range, 1-28 min). The majority of sonographers believed that immediate review improved communication, and 50% believed that it improved their job satisfaction.
  
  
  
  Review of initial outpatient echocardiographic examinations before patient discharge significantly improves study completeness. Review adds a nominal amount of time to total study duration, improves sonographer-physician communication, and may prevent unnecessary testing, potentially reducing the cost of care.
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: jtjohnson@luriechildrens.org.
authors.forename: Joyce T
authors.initials: JT
authors.lastname: Johnson
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Robinson
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Luciana T
authors.initials: LT
authors.lastname: Young
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Camarda
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D007087:Illinois; D007588:Job Satisfaction; D007755:Laboratories, Hospital / Q000706:statistics & numerical data*; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000706:statistics & numerical data*
keywords: Echocardiography; Job satisfaction; Pediatric; Quality improvement