Improved Knowledge of Pulmonary Hypertension Diagnosis Via Echocardiogram and Clinician Interpretation

Problem/Background: Pulmonary hypertension is a frequent diagnosis in the neonatal intensive care unit (NICU), which can be clinically challenging to diagnose. An echocardiogram is a non-invasive heart ultrasound which is the screening test of choice for pulmonary hypertension. However, the elements necessary to diagnose pulmonary hypertension are not always obtained and even when they are, the presence or absence of signs of pulmonary hypertension are not always included in the echocardiogram report. Without adequate echocardiogram reporting, combined with neonatal providers lack of specialized echocardiographic knowledge, infants have been misdiagnosed which can lead to increased infant morbidity and mortality, unnecessary treatment as well as increased hospital costs. Methods: This was a two part quality improvement project that took place in a level IV neonatal intensive care unit. The first part of the project included a retrospective chart review of echocardiogram reports performed for the indication of pulmonary hypertension, to evaluate if required elements for a pulmonary hypertension echocardiogram were being reported. To help improve reporting of pulmonary hypertension findings on echocardiogram, a presentation was given to the echocardiogram technicians and physicians which focused on obtaining the necessary information for an echocardiogram diagnosis of pulmonary hypertension and reporting those findings consistently in the echocardiogram reports. Another chart review was performed after this intervention to evaluate whether echocardiogram reporting for pulmonary hypertension had improved. The second part of the project entailed educating neonatal providers on interpreting pulmonary hypertension echocardiogram reports in the context of common clinical scenarios encountered in the NICU. This educational intervention was evaluated by giving the providers a pre and post survey. IMPROVED KNOWLEDGE OF PULMONARY HYPERTENSION 3 Results: There were 110 pre echocardiograms reviewed and 28 post echocardiograms reviewed. Following the educational intervention with the echocardiographic team, the echocardiogram reports improved. Pulmonary hypertension was reported 30% of the time on the pre echocardiogram reports and pulmonary hypertension was reported 64% of the time on the post echocardiogram reports (p-value 0.0007). There was an overall improvement in every variable except reporting of the TAPSE value. The pre and post surveys given to the providers showed significant improvement following the educational intervention. The surveys were paired which allowed 22 paired surveys to be used in the project. The demographics of the paired surveys included six Neonatologists, two Fellows, and fourteen Neonatal Nurse Practitioners. The mean score increased from 12.95 on the pre survey to 15.77 on the post survey (p-value 0.0059). Conclusion: Education is beneficial and can result in significant improvements in echocardiogram reporting of key elements used to diagnose pulmonary hypertension by echocardiogram and improvements in the ability of neonatal providers to interpret echocardiogram reports with regard to pulmonary hypertension. This in turn may improve the diagnosis and management of patients in the NICU.