VP02.21: Confluence of subspecialty training and birthrate decrease as an opportunity for the adequacy of care

Abstract

Objectives: Search the capacity for improvement based on the audit and prospective analysis of the diagnostic rate and its impact on healthcare quality. Methods: Tertiary national health hospital, the only for a 1 million inhabitants population. Centralisation of second trimester screening 20-22w ultrasound, 100% reach unselected population. Fetal malformations are scheduled for follow-up or TOP; explorers are certified; ultrasound methodology according to ISUOG guidelines; system: GE Voluson 730 Expert; all images are stored on hospital server. Data is collected daily in a congenital malformations registry, which is analysed prospectively and weekly on a Multidisciplinary Perinatological Committee, accredited by the Hospital. Accurate knowledge of false-negatives and true-positives, as well as evolution of the newborn. Results: Between 2014-2019, annual average of 7,189 scans was performed. 1,872 abnormal fetuses were diagnosed (4.7%). 98% were confirmed postnatally/autopsy. Found 73 false-negatives. Sensitivity 98.9%, specificity 99.8%, PPV 98% and NPV 99.7%. The most frequent are heart disease (61.2%, N = 1147) and CNS (16.5%, N = 308). These detailed data were the key to create both cardiology and neurology fetal and perinatal multidisciplinary committees (obstetrician, radiologist, pediatrician, pathologist, geneticist, along with a cardiologist, cardiac surgeon or neurologist), scheduling monthly sessions. There were 270 ILE (14, 4%),a decrease of 50% that exists in 2013. Conclusions: Continuous and prospective auditing, monitoring the false positives and negatives in heart and NCS diseases makes possible: