Purpose or Case Report: Growth in our hospital has resulted in multiple new locations opening which has resulted in staffing by ultrasound technologists lesser experienced in appendicitis imaging. Likewise, our ordering providers have increased their push to reduce CT utilization. Our aim was to improve the appendix visualization frequency by 10% over 6 months to reduce exposure to ionizing radiation, reduce cost for families, lower risk to patients, reduce length of stay in the emergency department, and shorten the time to diagnosis.
Methods & Materials: Appendicitis ultrasound data month over month was collected both at the department and sonographer level was collected. The data was reviewed with the ultrasound team each month. Metrics assessed included visualization of the appendix (full, partial, not seen), if additional imaging was performed, and if acute appendicitis was seen on follow-up imaging. Individual sonographer statistics were reviewed in a one-on-one environment Implementation of new ultrasound appendix exam protocol by requiring a second sonographer to attempt appendix localization if available.
Results: Before the implementation of the appendix quality initiative, our collective visualization frequency was 50%. After implementation of new protocols and case review as a team and on the individual level, our department find rate improved by 20%. A review of publications found that the great majority of appendix find rates were calculated by including partially seen appendixes in the count for successful visualization. We derived our outcomes from full visualization of the appendix. Month over month, the number of cases positive for acute appendicitis that were not seen by ultrasound decreased. Through our processes, we reduced the percentage of patients receiving additional imaging from 20% down to less than 9%. Given the success of this quality initiative, we plan to continue the process moving forward.
Conclusions: One-to-one sonographer coaching and second technologist over-scanning significantly improved sonographic visualization of the pediatric appendix.