Quality Improvement Report: Decreasing Incorrectly Scheduled Screening US for Hip Dysplasia in Premature Infants

Screening US for developmental dysplasia of the hip in infants with risk factors should optimally be performed after 6 weeks corrected gestational age (CGA). Scanning before this age leads to higher false-positive rates and the potential need for repeat examination, which creates waste and undue stress on the child and family. Pediatric radiologists at the authors' institution observed that many premature infants were being scheduled too early for their screening US. This quality improvement project aimed to decrease incorrectly scheduled screening examinations from a baseline rate of 50% to less than 25% within 6 months. Key drivers and interventions addressed the lack of clarity regarding whether the examination was screening or diagnostic (physical examination finding), poor visibility and manual calculation of CGA by schedulers, and lack of automated scheduling guidance. Ordering clinicians were educated, and an electronic health record (EHR) report was created to prospectively identify examinations that may need rescheduling. Next, a mandatory order question was added in the EHR to clearly identify which examinations were ordered for screening, with embedded guidance for schedulers to time these examinations after 6 weeks CGA. Finally, a special work queue was created to leverage the expertise of certain schedulers assigned to this task. After the final plan-do-study-act cycle, incorrectly scheduled examinations decreased from 50% to 10%. By using people- (specialized scheduling team), process- (dedicated work queue), and system-related (EHR order question with scheduling guidance) interventions, the group was able to create and sustain change and decreased incorrectly scheduled pediatric hip US examinations by 80%. ^©RSNA, 2025.