Improving pediatric sonographer visualization of the superior mesenteric vasculature: A local quality improvement initiative.

Background: Ultrasound is emerging as a viable first-line imaging modality in the assessment of midgut volvulus. However, successful transition to this technique can be challenging.

Objective: The aim of our project was to increase sonographer visualization rates of the superior mesenteric artery and superior mesenteric vein (SMA/SMV) by >39 % from baseline over a 7-month period.

Methods: We conducted a quality improvement project targeting the ultrasound department at a large academic children's hospital system. The study included 615 patients who underwent pyloric or volvulus ultrasounds. Interventions included implementation of a team goal, monthly review of deficient exams and radiologist to sonographer peer review. Our primary outcome measure was percentage of exams in which the SMA/SMV vascular pedicle was successfully visualized.

Results: The average baseline rate of SMA/SMV visualization was 37 %. This rate increased to 72 % within one month of implementation, and an average of 83 % visualization was achieved over the 7-month period of observation. This improvement was sustained during the 2 months immediately following the conclusion of the formal observation period and remained evident 2 years post-completion.

Conclusion: Our quality improvement initiative resulted in significant, rapid, and sustained improvement in sonographer visualization rates of the superior mesenteric vasculature. Given widespread interest in volvulus ultrasound, we provide a framework for successfully training sonographers to perform this exam. The approach we used may also have potential to be utilized in the implementation of other imaging protocols.