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Structured coaching as a means to improve sonographic visualization of the appendix: a quality improvement initiative

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Abstract

Purpose

Ultrasound of the right lower quadrant for appendicitis requires specific training and practice. Improved visualization of the appendix can result in decreased utilization of computed tomography. Increasing the sensitivity of ultrasound for appendicitis thus decreases radiation exposure, reduces cost, and improves the patient healthcare experience in accordance with the three principles of the triple aim designated by the Institute for Healthcare Improvement. The purpose of this study was to examine the effect of a structured training program supplemented by technologist feedback on sonographic visualization of the appendix in a large pediatric health system.

Methods

The baseline ultrasound visualization frequency was computed for 20 ultrasound technologists in a large pediatric health system. Following this, technologists were informed of their individual and relative performance. Those with visualization frequencies less than 75% were provided structured training by a designated sonographer with an appendix visualization frequency above 75% while those with greater than 75% visualization continued to be monitored and informed of their monthly frequency. Following this structured training, appendix visualization frequencies were monitored over the next 5 months.

Results

There was no significant effect of sonographer career experience on the baseline appendix visualization frequency. Fourteen of 20 technologists demonstrated improved visualization frequencies post-intervention. The composite visualization frequency among these 20 technologists improved from 66.55 to 69.14%. This resulted in a potential savings of 38 CT scans during the post-intervention period.

Conclusion

An appendix visualization rate monitoring program coupled with structured training was successful in improving the appendix visualization rate throughout a large pediatric health system. This program demonstrates the positive effect that monitoring and targeted intervention can have on a quality improvement program. The program continues to be carried out as part of a plan-study-do-act cycle.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Radiology, Phoenix Children’s, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA

    Cory M. Pfeifer

  2. Department of Radiology, Children’s Health, 1935 Medical District Dr, Dallas, TX, 75235, USA

    Brittany Carrejo, Samantha Lewis, Kelly Hutchinson & Jeannie Kwon

  3. Department of Radiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY, 10305, USA

    Ami Gokli

  4. Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Jeannie Kwon

Authors
  1. Cory M. Pfeifer
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  2. Brittany Carrejo
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  3. Samantha Lewis
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  4. Kelly Hutchinson
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  5. Ami Gokli
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  6. Jeannie Kwon
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Correspondence to Cory M. Pfeifer.

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Pfeifer, C.M., Carrejo, B., Lewis, S. et al. Structured coaching as a means to improve sonographic visualization of the appendix: a quality improvement initiative. Emerg Radiol 30, 161–166 (2023). https://doi.org/10.1007/s10140-022-02106-5

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  • DOI: https://doi.org/10.1007/s10140-022-02106-5

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