Aims To produce departmental guidelines citing clinical indications regarding the frequency and appropriateness of cranial ultrasound scanning.
To improve documentation and planning of scans to improve time management.
To enhance trainee opportunities in performing and interpreting scans under expert supervision, ultimately leading to improved service provision and confident independent practise.
Methods Part 1
Senior speciality paediatric trainee questionnaire to frame context of audit: to assess confidence in performing and interpreting (P&I) cranial ultrasound scans (CrUS) on modified Likert scale; data interpretation questions (published questionnaires, author’s permission to use) to gauge ability to identify abnormalities, to decide immediate management and discuss prognosis.
Full audit cycle of CrUS compliance, implementation and assessment of changes. Audit (cycle 1) over 12-day consecutive period with re-audit 6 months later (cycle 2) after implementing changes.
Results Part 1
Trainees reported little confidence with P&I.
All identified major abnormality in each image with sensible answers provided regarding management, however limited information regarding prognosis.
Poor compliance, documentation and lack of follow up.
Loose scans with no date, time or comment.
No baby had a Standard Electronic Neonatal Database (SEND) CrUS form completed.
Weekly teaching with Radiologist experienced in CrUS.
Comprehensive guideline including indications and separate proforma for every baby admitted to the unit prompting an assessment for CrUS.
Posters next to scanner and computers to remind users to document findings on SEND.
Presentation of results.
Improved compliance rate from 60.0% to 71.4%
Improved documentation from 28.6% to 100% including signature and level of supervision.
80% of scans documented had plan for follow up scan.
No baby had SEND CrUS form completed.
Conclusions Trainee confidence in P&I scans improves with regular Radiology teaching sessions. Dedicated guidelines and proforma improve assessment for scanning, compliance, documentation and work load planning; this improves patient care and enhances service provision. Future action: to standardise CrUS guidelines throughout the Neonatal Network to improve continuity of care.
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