Engaging Sonographers to Improve Prenatal Screening for Heart Defects in Practice

Lay Summary: The goal of our research was to understand barriers to detecting heart defects before birth from the perspective of those at the forefront of the screening process. We performed a national survey of sonographers to examine the association between barriers they identified that make screening difficult and their ability to recognize abnormal fetal hearts on web images. We did not reach our goal number of participants with our initial sample mailings so we pulled a second sample list of sonographers and mailed them recruitment material. We are currently finishing this second stage of the survey and plan to analyze results this fall and present our findings at the next meeting for the American Society of Echocardiography. Saving tiny Hearts Society funding and the progress of this project contributed to our success in obtaining a NIH award from the Pediatric Heart Network for use of a similar design for identifying barriers from the perspective of the doctors who care for women during pregnancy and interpret screening ultrasounds.

 

The American Society of Echocardiography recently released a statement recognizing the need to improve prenatal detection and to focus efforts on ways to improve screening. We believe our studies will fill an important gap in knowledge by providing new insight into the relevant factors that really impact our ability to screen for heart defects and identify targets that have a higher likelihood of actually changing clinical practice. Some areas already identified include lack of feedback for physicians and sonographers on their performance, lack of patient knowledge about the purpose of the scan and lack of recognition of the importance of the quality of the scan they are getting. In addition, baseline standards must be developed and maintained for performing screening ultrasounds and processes to enforce this standard must be identified. Finally, and perhaps most importantly, there is a knowledge gap for physicians and sonographers who perform screening ultrasounds on how much CHD is being missed prenatally and the impact of these misses on the child and their family. We plan to use our quantitative results from both studies to design a pragmatic trial and apply for additional grant funding from the NIH or American Heart Association.