Infant cranial ultrasound: Applying practice development principles to enhance service delivery

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Abstract

Aim

To explore the potential for local delivery of evidence based practice by supplementing a secondary care infant cranial ultrasound protocol with one used at a tertiary referral centre.

Method

A single practitioner used ‘Practice Development’ methodology to learn, implement and evaluate the impact of adding supplementary (postero-lateral) fontanelle scanning to the anterior fontanelle infant cranial ultrasound examination routinely used at one District General Hospital (DGH). Over a 7 week period (March and April 2010) twenty one infants were scanned using both the routine (anterior fontanelle) and the new (additional postero-lateral fontanelle) technique. Images were evaluated by an independent tertiary referral centre expert (consultant neuroradiologist) to compare posterior cranial fossa visualisation and obtain a diagnostic second opinion. Pathology prevalence, posterior fossa visualisation and diagnostic agreement between local and tertiary referral opinions were compared.

Results

Visualisation of the posterior cranial fossa was considered to be subjectively improved for the multiple fontanelle technique. The required associated increase in overall examination time did not necessitate additional infant handling. This small pilot study did not show any statistically significant improvement in intracranial pathology detection.

Conclusion

This study suggests that provision of multiple fontanelle scanning is practically feasible in a secondary care setting. Continued monitoring of diagnostic outcomes is required to assess its clinical value.

Introduction

Health care services which reflect the best interests of patients and carers are an important component of contemporary service provision (Chin and McNichol, 2000). Any evaluation of health care delivery should consider impact at practitioner, patient, service delivery and organisational levels (Page and Hamer, 2002).

This study was undertaken at a secondary care provider (District General Hospital) which has a strategic objective to provide evidenced based accessible care close to the patient's home (Beard, 2010). The aim of the study was to assess the feasibility of improving diagnostic outcomes by creating an infant cranial ultrasound service at a similar level of technical complexity to that delivered at a geographically distant tertiary referral center.

The emancipatory ‘Practice Development’ methods employed in this study are characterised by a transformational culture, a shared vision for positive change, shared responsibility and staff development perspectives (Manley and McCormack, 2003).

Section snippets

Background

Diagnostic tests are used to establish and monitor the presence of disease, inform treatment and assess prognosis (Mant, 2005). Infant Cranial Ultrasound (CUS) is performed to assess and monitor the infant brain (Maalouf et al., 2001). It can be performed in infants up to approximately 15 months of age (Siegel, 2007) but is most commonly used in the neonatal period (Larroque et al., 2003) where it helps guide clinical management and provides a basis for long term prognosis of neurodevelopmental

Methods

Practice Development (PD) is a term used to describe methods for developing healthcare practice (Manley et al., 2008). Historically its nature and scope is poorly defined (Unsworth, 2000), however, more recently the term has become associated with the concepts of continuous quality improvement and excellence in practice (McSherry and Warr, 2006).

In this study PD was operationalised in six stages.

Acknowledgement

This study was conducted in partial fulfillment for the award of MSc Medical Ultrasound at the University of Leeds.

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