P2.008: Optimizing Outpatient Follow-up of Non-Emergent Neonatal Echocardiography By Altering the Role of the Echocardiographer

Purpose/Objectives: Neonatal echocardiograms are frequently performed in the newborn nursery and neonatal intensive care unit to identify clinically significant heart disease. However, many of these studies identify issues where need for or timing of follow-up may not be immediately clear to the primary care provider, newborn hospitalist or neonatologist. Although they might not be directly involved in the care of newborns with non-emergent echo findings, the cardiologist reading the echocardiogram might be in the best position to determine optimal follow-up. Traditionally, cardiologists viewed their role in this setting to describe the anatomy but not to provide clinical recommendations unless they were directly involved in the patient’s care. In the hopes of optimizing that follow-up care, we chose to use the echocardiogram’s report not only to describe the anatomy, but also to include clinical recommendations for follow-up.

Design/Methods: We chose a plan-do-study-act process commonly recommended for continuing improvement. Baseline data was collected using final newborn echocardiogram reports with non-emergent findings performed in the Newborn Nursery and Neonatal Intensive Care Unit. Babies were excluded if they had any heart disease that would require intervention or weighed less than 2 kilograms at the time of the echo. This data was collected 20 weeks prior to the first intervention, 10 weeks after the first intervention (reporting cardiologists agreement to include follow up recommendations in their report), and 10 weeks after the second intervention (modification of the echo reporting system to include standardized follow-up statements determined by the cardiologists).
Providers who order neonatal echocardiograms and the nursing staff charged with coordinating follow-up were surveyed on their satisfaction with the echo reporting process before the first intervention and ten weeks after the second intervention.

Results: The baseline data included 127 echocardiograms that met the indicated criteria, of which 38/127(29.9%) included follow up recommendations. In the ten weeks after the first intervention, 55 echocardiograms met inclusion criteria, of which 30/55(54.5%) included follow up recommendations. In the ten weeks after the second intervention, 85 echocardiograms met inclusion criteria, of which 54/85(63.5%) included follow up recommendations (Table 1).
Although most providers who order neonatal echocardiograms and the scheduling nurses reported overall satisfaction with the echocardiographic reporting process prior to project initiation, their satisfaction did improve after implementation.

Conclusion/Discussion: In this project we hoped to improve overall care of newborns with non-critical echocardiographic findings by expanding the role of the echocardiographer beyond anatomic description to clinical recommendation. Even with incomplete adoption of clinical recommendations, we were able to show increased satisfaction with the overall echo reporting system among those providers ordering neonatal echocardiograms and those nurses charged with coordinating follow-up care of the babies in question.