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

AI Article Synopsis

  • Individuals with sickle cell disease (SCD) are advised to have annual stroke risk assessments via transcranial Doppler (TCD) screening, yet adherence rates for this screening remain low, even at Boston Children's Hospital.* -
  • A quality improvement initiative was launched, using three plan-do-study-act (PDSA) cycles, with a goal of increasing TCD adherence rates to above 95% within 15 months.* -
  • Results showed a significant increase in TCD adherence from 67% to 92% over the course of the initiative, marking this project as the first to show sustained improvement in screening rates for SCD over an eight-year period.*

Article Abstract

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).

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Source
http://dx.doi.org/10.1002/pbc.31088DOI Listing

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