Engaging Sonographers to Improve Prenatal Screening for Heart Defects in Practice (2012-2013)
Nelangi M. Pinto, MD
University of Utah
With early detection and treatment, survival and long-term outcomes for CHD are improving. Screening for CHD before birth is a way in which CHD can be diagnosed. Identifying CHD before birth also allows for planned deliveries at centers that can provide appropriate care and allows physicians to counsel families prenatally so they have some time to consider treatment options and expected outcomes before their child is born. Most mothers who have a child with CHD do not have any risk factors, so all mothers are screened at the time of their prenatal ultrasound. However, prenatal ultrasound misses most CHD in the US (>50%) even though it has been proven to be very sensitive in certain settings.
This study proposes to engage the sonographers who perform prenatal ultrasounds to get their perspective on what obstacles exist to obtaining the standard images needed to screen for CHD. We know that screening is most successful in academic hospitals, but this is not where most pregnant mothers have their screening ultrasound. Thus, we need to understand what may differ for practicing sonographers and physicians who perform these ultrasounds in other types of practices. We will gather information using a web survey that will allow all sonographers practicing throughout the United States to and to be represented in our results. This survey asks sonographers questions about what factors influence their ability to obtain screening images of the fetal heart. It also evaluates their ability to perform imaging in a number of ways, including asking them to interpret images of the fetal heart that are presented to them by digital video clips.
Understanding what is needed for more effective screening, whether that is changes in policy, more consistent and accessible training, better systems for reliable feedback, higher expectations from supervisors, more time for scanning or better institutional support or equipment and how these needs may differ for sonographers who practice in different settings will help us ultimately design a more effective intervention to improve prenatal detection of CHD throughout the United States.