{Reference Type}: Journal Article
{Title}: Sustained increase in annual transcranial Doppler screening rates in children with sickle cell disease: A quality improvement project.
{Author}: Edwards JG;Yan AP;Yim R;Oni M;Heeney MM;Johnson D;Wong CI;Ilowite M;Archer NM;
{Journal}: Pediatr Blood Cancer
{Volume}: 71
{Issue}: 8
{Year}: 2024 Aug 29
{Factor}: 3.838
{DOI}: 10.1002/pbc.31088
{Abstract}: <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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).