Sustained increase in annual transcranial Doppler screening rates in children with sickle cell disease: A quality improvement project.

Autor: Edwards JG; Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA., Yan AP; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.; Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada., Yim R; Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA., Oni M; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA., Heeney MM; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA., Johnson D; Boston Children's Hospital Program for Patient Safety and Quality, Boston, Massachusetts, USA., Wong CI; Division of Hematology/Oncology, Rainbow Babies and Children's Hospital and Seidman Cancer Center, University Hospitals, Cleveland, Ohio, USA., Ilowite M; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA., Archer NM; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2024 Aug; Vol. 71 (8), pp. e31088. Date of Electronic Publication: 2024 May 29.
DOI: 10.1002/pbc.31088
Abstrakt: Introduction: Individuals with sickle cell disease (SCD) at increased risk for stroke should undergo annual stroke risk assessment using transcranial Doppler (TCD) screening between the ages of 2 and 16. Though this screening can significantly reduce morbidity associated with SCD, screening rates at Boston Children's Hospital (and nationwide) remain below the recommended 100% screening adherence rates.
Methods: Three plan-do-study-act (PDSA) cycles were designed and implemented. The Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) aim of our quality improvement (QI) initiative was to sustainably increase the proportion of eligible patients receiving a TCD within 15 months of their last TCD to greater than 95%. An interrupted time series (ITS) analysis was performed, comparing TCD adherence rates from PDSA Cycle 1 to those from PDSA Cycles 2 and 3.
Results: Mean TCD adherence increased across all three PDSA cycles, from a baseline of 67% in the first cycle (January 2015 to September 2020) to 92% in the third cycle (May 2021 to March 2023). In the ITS analysis of TCD adherence rates, there was a significant difference in the final TCD adherence rate achieved compared to the rate predicted, with a total estimated increase in adherence of 17.9% being attributable to the interventions from PDSA Cycles 2 and 3.
Discussion: Although other QI initiatives had demonstrated ability to increase adherence to TCD screening for patients with SCD, this is the first QI project to collect data over such a prolonged period of time to demonstrate a sustained increase in screening rates throughout the intervention (an 8-year period).
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
Externí odkaz: