OP17.03: Teleconference tutorials to improve individual operator distributions for nuchal translucency measurement

Abstract

Objectives:To estimate the risk of miscarriage and stillbirth following first trimester risk assessment among women pregnant after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) or intrauterine insemination (IUI) compared to spontaneously conceived pregnancies (SCP) Objectives: To develop an intervention to assist operators to improve their NT (nuchal translucency) technique with the aim of having a NT distribution within the appropriate range. Methods: All Australian operators who are accredited to measure NT undergo annual review of their clinical practice. Their NT data is assessed to check that an acceptable proportion of measurements (40-60%) lie above the gestation-related median. Operators with NT distributions falling outside of the acceptable range undertook a teleconference tutorial.Tutorials were offered on a fortnightly basis and involved two tutors, a sonographer experienced in NT education and the quality program manager. The tutorial lasted 60 minutes. By using desktop sharing software the operators and the tutors were able to review a series of images together and establish a mechanism for improving operator technique. The quality program manager reinforced the concepts of audit, how performance is measured and how the first trimester screening software program calculates the risks for Down syndrome and other chromosome abnormalities. Discussion was encouraged in an attempt to dispel some common misconceptions. Results: In 2011 there were 1254 operators performing NT scans in Australia. After the annual audit in 2011, 106 operators were found to have a NT distribution falling outside the acceptable range, 98 operators were under-measuring and 8 were over-measuring (range: 8.43% -83.33% above the median), these operators undertook a teleconference tutorial.In the 2012 audit of results 103 of these106 operators remained active, 69/103 (71.07%) had improved their distributions to the acceptable range. Conclusions: Teleconference Tutorials are an effective way of improving operator distributions for NT measurement.