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Training: improving antenatal detection and outcomes of congenital heart disease

Orhan Uzun, Julia Kennedy, Colin Davies, Anthony Goodwin, Nerys Thomas, Delyth Rich, Andrea Thomas, David Tucker, Bryan Beattie, Michael Lewis

BMJ Open Quality, Volume: 7, Issue: 4, Start page: e000276

Swansea University Author: Michael Lewis

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DOI (Published version): 10.1136/bmjoq-2017-000276

Abstract

Objectives This study describes the design, delivery and efficacy of a regional fetal cardiac ultrasound training programme. This programme aimed to improve the antenatal detection of congenital heart disease (CHD) and its effect on fetal and postnatal outcomes.Design setting and participants This w...

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Published in: BMJ Open Quality
ISSN: 2399-6641
Published: BMJ 2018
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2023-03-14T11:43:09.3827994</datestamp><bib-version>v2</bib-version><id>44409</id><entry>2018-09-19</entry><title>Training: improving antenatal detection and outcomes of congenital heart disease</title><swanseaauthors><author><sid>b59c8f5c056bac7e6995385f22ad1639</sid><firstname>Michael</firstname><surname>Lewis</surname><name>Michael Lewis</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2018-09-19</date><deptcode>FGSEN</deptcode><abstract>Objectives This study describes the design, delivery and efficacy of a regional fetal cardiac ultrasound training programme. This programme aimed to improve the antenatal detection of congenital heart disease (CHD) and its effect on fetal and postnatal outcomes.Design setting and participants This was a prospective study that compared antenatal CHD detection rates by professionals from 13 hospitals in Wales before and after engaging in our &#x2018;skills development programme&#x2019;. Existing fetal cardiac practice and perinatal outcomes were continuously audited and progressive targets were set. The work was undertaken by the Welsh Fetal Cardiovascular Network, Antenatal Screening Wales (ASW), a superintendent sonographer and a fetal cardiologist.Interventions A core professional network was established, engaging all stakeholders (including patients, health boards, specialist commissioners, ASW, ultrasonographers, radiologists, obstetricians, midwives and paediatricians). A cardiac educational lead (midwife, superintendent sonographer, radiologist, obstetrician, or a fetal medicine specialist) was established in each hospital. A new cardiac anomaly screening protocol (&#x2018;outflow tract view&#x2019;) was created and training on the new protocol was systematically delivered at each centre. Data were prospectively collected and outcomes were continuously audited: locally by the lead fetal cardiologist; regionally by the Congenital Anomaly Register and Information Service in Wales; and nationally by the National Institute for Cardiac Outcomes and Research (NICOR) in the UK.Main outcome measures Patient satisfaction; improvements in individual sonographer skills, confidence and competency; true positive referral rate; local hospital detection rate; national detection rate of CHD; clinical outcomes of selected cardiac abnormalities; reduction of geographical health inequality; cost efficacy.Results High levels of patient satisfaction were demonstrated and the professional skill mix in each centre was improved. The confidence and competency of sonographers was enhanced. Each centre demonstrated a reduction in the false-positive referral rate and a significant increase in cardiac anomaly detection rate. According to the latest NICOR data, since implementing the new training programme Wales has sustained its status as UK lead for CHD detection. Health outcomes of children with CHD have improved, especially in cases of transposition of the great arteries (for which no perinatal mortality has been reported since 2008). Standardised care led to reduction of geographical health inequalities with substantial cost saving to the National Health Service due to reduced false-positive referral rates. Our successful model has been adopted by other fetal anomaly screening programmes in the UK.Conclusions Antenatal cardiac ultrasound mass training programmes can be delivered effectively with minimal impact on finite healthcare resources. Sustainably high CHD detection rates can only be achieved by empowering the regional screening workforce through continuous investment in lifelong learning activities. These should be underpinned by high quality service standards, effective care pathways, and robust clinical governance and audit practices.</abstract><type>Journal Article</type><journal>BMJ Open Quality</journal><volume>7</volume><journalNumber>4</journalNumber><paginationStart>e000276</paginationStart><paginationEnd/><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2399-6641</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>11</publishedMonth><publishedYear>2018</publishedYear><publishedDate>2018-11-01</publishedDate><doi>10.1136/bmjoq-2017-000276</doi><url>http://dx.doi.org/10.1136/bmjoq-2017-000276</url><notes/><college>COLLEGE NANME</college><department>Science and Engineering - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGSEN</DepartmentCode><institution>Swansea University</institution><apcterm/><funders/><projectreference/><lastEdited>2023-03-14T11:43:09.3827994</lastEdited><Created>2018-09-19T09:20:31.2375721</Created><path><level id="1">Faculty of Science and Engineering</level><level id="2">School of Engineering and Applied Sciences - Sport and Exercise Sciences</level></path><authors><author><firstname>Orhan</firstname><surname>Uzun</surname><order>1</order></author><author><firstname>Julia</firstname><surname>Kennedy</surname><order>2</order></author><author><firstname>Colin</firstname><surname>Davies</surname><order>3</order></author><author><firstname>Anthony</firstname><surname>Goodwin</surname><order>4</order></author><author><firstname>Nerys</firstname><surname>Thomas</surname><order>5</order></author><author><firstname>Delyth</firstname><surname>Rich</surname><order>6</order></author><author><firstname>Andrea</firstname><surname>Thomas</surname><order>7</order></author><author><firstname>David</firstname><surname>Tucker</surname><order>8</order></author><author><firstname>Bryan</firstname><surname>Beattie</surname><order>9</order></author><author><firstname>Michael</firstname><surname>Lewis</surname><order>10</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2023-03-14T11:43:09.3827994 v2 44409 2018-09-19 Training: improving antenatal detection and outcomes of congenital heart disease b59c8f5c056bac7e6995385f22ad1639 Michael Lewis Michael Lewis true false 2018-09-19 FGSEN Objectives This study describes the design, delivery and efficacy of a regional fetal cardiac ultrasound training programme. This programme aimed to improve the antenatal detection of congenital heart disease (CHD) and its effect on fetal and postnatal outcomes.Design setting and participants This was a prospective study that compared antenatal CHD detection rates by professionals from 13 hospitals in Wales before and after engaging in our ‘skills development programme’. Existing fetal cardiac practice and perinatal outcomes were continuously audited and progressive targets were set. The work was undertaken by the Welsh Fetal Cardiovascular Network, Antenatal Screening Wales (ASW), a superintendent sonographer and a fetal cardiologist.Interventions A core professional network was established, engaging all stakeholders (including patients, health boards, specialist commissioners, ASW, ultrasonographers, radiologists, obstetricians, midwives and paediatricians). A cardiac educational lead (midwife, superintendent sonographer, radiologist, obstetrician, or a fetal medicine specialist) was established in each hospital. A new cardiac anomaly screening protocol (‘outflow tract view’) was created and training on the new protocol was systematically delivered at each centre. Data were prospectively collected and outcomes were continuously audited: locally by the lead fetal cardiologist; regionally by the Congenital Anomaly Register and Information Service in Wales; and nationally by the National Institute for Cardiac Outcomes and Research (NICOR) in the UK.Main outcome measures Patient satisfaction; improvements in individual sonographer skills, confidence and competency; true positive referral rate; local hospital detection rate; national detection rate of CHD; clinical outcomes of selected cardiac abnormalities; reduction of geographical health inequality; cost efficacy.Results High levels of patient satisfaction were demonstrated and the professional skill mix in each centre was improved. The confidence and competency of sonographers was enhanced. Each centre demonstrated a reduction in the false-positive referral rate and a significant increase in cardiac anomaly detection rate. According to the latest NICOR data, since implementing the new training programme Wales has sustained its status as UK lead for CHD detection. Health outcomes of children with CHD have improved, especially in cases of transposition of the great arteries (for which no perinatal mortality has been reported since 2008). Standardised care led to reduction of geographical health inequalities with substantial cost saving to the National Health Service due to reduced false-positive referral rates. Our successful model has been adopted by other fetal anomaly screening programmes in the UK.Conclusions Antenatal cardiac ultrasound mass training programmes can be delivered effectively with minimal impact on finite healthcare resources. Sustainably high CHD detection rates can only be achieved by empowering the regional screening workforce through continuous investment in lifelong learning activities. These should be underpinned by high quality service standards, effective care pathways, and robust clinical governance and audit practices. Journal Article BMJ Open Quality 7 4 e000276 BMJ 2399-6641 1 11 2018 2018-11-01 10.1136/bmjoq-2017-000276 http://dx.doi.org/10.1136/bmjoq-2017-000276 COLLEGE NANME Science and Engineering - Faculty COLLEGE CODE FGSEN Swansea University 2023-03-14T11:43:09.3827994 2018-09-19T09:20:31.2375721 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Orhan Uzun 1 Julia Kennedy 2 Colin Davies 3 Anthony Goodwin 4 Nerys Thomas 5 Delyth Rich 6 Andrea Thomas 7 David Tucker 8 Bryan Beattie 9 Michael Lewis 10
title Training: improving antenatal detection and outcomes of congenital heart disease
spellingShingle Training: improving antenatal detection and outcomes of congenital heart disease
Michael Lewis
title_short Training: improving antenatal detection and outcomes of congenital heart disease
title_full Training: improving antenatal detection and outcomes of congenital heart disease
title_fullStr Training: improving antenatal detection and outcomes of congenital heart disease
title_full_unstemmed Training: improving antenatal detection and outcomes of congenital heart disease
title_sort Training: improving antenatal detection and outcomes of congenital heart disease
author_id_str_mv b59c8f5c056bac7e6995385f22ad1639
author_id_fullname_str_mv b59c8f5c056bac7e6995385f22ad1639_***_Michael Lewis
author Michael Lewis
author2 Orhan Uzun
Julia Kennedy
Colin Davies
Anthony Goodwin
Nerys Thomas
Delyth Rich
Andrea Thomas
David Tucker
Bryan Beattie
Michael Lewis
format Journal article
container_title BMJ Open Quality
container_volume 7
container_issue 4
container_start_page e000276
publishDate 2018
institution Swansea University
issn 2399-6641
doi_str_mv 10.1136/bmjoq-2017-000276
publisher BMJ
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Engineering and Applied Sciences - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Sport and Exercise Sciences
url http://dx.doi.org/10.1136/bmjoq-2017-000276
document_store_str 0
active_str 0
description Objectives This study describes the design, delivery and efficacy of a regional fetal cardiac ultrasound training programme. This programme aimed to improve the antenatal detection of congenital heart disease (CHD) and its effect on fetal and postnatal outcomes.Design setting and participants This was a prospective study that compared antenatal CHD detection rates by professionals from 13 hospitals in Wales before and after engaging in our ‘skills development programme’. Existing fetal cardiac practice and perinatal outcomes were continuously audited and progressive targets were set. The work was undertaken by the Welsh Fetal Cardiovascular Network, Antenatal Screening Wales (ASW), a superintendent sonographer and a fetal cardiologist.Interventions A core professional network was established, engaging all stakeholders (including patients, health boards, specialist commissioners, ASW, ultrasonographers, radiologists, obstetricians, midwives and paediatricians). A cardiac educational lead (midwife, superintendent sonographer, radiologist, obstetrician, or a fetal medicine specialist) was established in each hospital. A new cardiac anomaly screening protocol (‘outflow tract view’) was created and training on the new protocol was systematically delivered at each centre. Data were prospectively collected and outcomes were continuously audited: locally by the lead fetal cardiologist; regionally by the Congenital Anomaly Register and Information Service in Wales; and nationally by the National Institute for Cardiac Outcomes and Research (NICOR) in the UK.Main outcome measures Patient satisfaction; improvements in individual sonographer skills, confidence and competency; true positive referral rate; local hospital detection rate; national detection rate of CHD; clinical outcomes of selected cardiac abnormalities; reduction of geographical health inequality; cost efficacy.Results High levels of patient satisfaction were demonstrated and the professional skill mix in each centre was improved. The confidence and competency of sonographers was enhanced. Each centre demonstrated a reduction in the false-positive referral rate and a significant increase in cardiac anomaly detection rate. According to the latest NICOR data, since implementing the new training programme Wales has sustained its status as UK lead for CHD detection. Health outcomes of children with CHD have improved, especially in cases of transposition of the great arteries (for which no perinatal mortality has been reported since 2008). Standardised care led to reduction of geographical health inequalities with substantial cost saving to the National Health Service due to reduced false-positive referral rates. Our successful model has been adopted by other fetal anomaly screening programmes in the UK.Conclusions Antenatal cardiac ultrasound mass training programmes can be delivered effectively with minimal impact on finite healthcare resources. Sustainably high CHD detection rates can only be achieved by empowering the regional screening workforce through continuous investment in lifelong learning activities. These should be underpinned by high quality service standards, effective care pathways, and robust clinical governance and audit practices.
published_date 2018-11-01T03:55:36Z
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score 11.012791

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