Page 58 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
th
11 National QA Convention, 4 – 6 October 2022
PP-20

Reducing High Failure Rate of Computed Tomography Pulmonary Artery/Contrast
Enhanced Computed Tomography (CTPA/CECT) Thorax Examinations in Children in
Hospital Seberang Jaya

Tan PP , Ling SR , Siti Aisyah Z , Shalina Shoni I , Mohana ME , Rahmah Y 2
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1
1
1
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1 Radiology Department, Hospital Seberang Jaya, Pulau Pinang,
2 Paediatrics Department, Hospital Seberang Jaya, Pulau Pinang
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
High failure rate of CTPA/CECT Thorax examinations in children (50%) was identified in Radiology
Department at Hospital Seberang Jaya in 2019. Consequently, it had led to delayed/inappropriate management
and unnecessary radiation dose to the patients due to repeated studies.

KEY MEASURES FOR IMPROVEMENT:
The indicator used was the percentage of failure rate of CTPA/CECT Thorax examinations in children with a
standard of <10%.

PROCESS OF GATHERING INFORMATION:
This descriptive cross-sectional study was conducted from January 2019 to January 2022 through a universal
sampling method targeting all CTPA/CECT Thorax examinations in children 18 years old and below.
Observational and knowledge/performance checklists were utilised to collect the required data and subjected
them to further analysis.

ANALYSIS AND INTERPRETATION:
The failure rate of CTPA/CECT thorax examinations in children from May to July 2019 was 40%. The
contributing factors were the failure of radiographers in performing optimal CTPA/CECT Thorax (100%),
poor image post-processing (90%), poor patient preparation (30%) and equivocal radiologist report (5%). The
ABNA was 30%.

STRATEGIES FOR CHANGE:
Dual bolus intravenous contrast injection (DBI) technique is the main new intervention. We also implement
continuous CME and training for radiographers, supervision of radiographers, revision of paediatric sedation
protocol and reporting CTPA in children under supervision.

EFFECTS OF CHANGE:
The failure rate of CTPA/CECT thorax examinations in children has reduced to 9% in January 2022. Improvement
in MOGC is seen as a success in performing CTPA/CECT Thorax (100%), optimum image post-processing
(100%), adequate patient preparation (97%) and accurate radiologist report (100%). It helps in procedure cost
saving, avoiding unnecessary radiation to patients, providing accurate diagnosis and management, reducing
patient’s anxiety, parents’ absenteeism in the workplace and staffs’ workloads.

THE NEXT STEP:
DBI technique has been implemented in the Radiology Department, Hospital Pulau Pinang and successfully
reduced the failure rate of CTPA examinations in children. We wish to introduce the DBI technique to Radiology
Department in other states.

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