Submitted by MinhAnh Hoang, communications co-op student, Physician Quality Improvement

A quality improvement project led by Dr. Shafique Pirani brought down the missed screening hip ultrasound rate at Royal Columbian Hospital, improving outcomes for babies and minimizing the need for hip replacement later in life.

Developmental dysplasia of the hip (DDH) is a common condition in infants where the hip socket is shallow and the hip joint is loose and can dislocate. Being painless, it is easy to miss. Missed or delayed diagnosis results in a limp, arthritis and disability requiring surgery later in childhood. It is the reason for 10 to 23 per cent of hip replacement in adults.

Guidelines recommend all high-risk newborns undergo a screening hip ultrasound at six weeks of age to facilitate timely diagnosis and effective non-surgical treatment. In order to ensure these guidelines are being met at Royal Columbian Hospital (RCH), Dr. Shafique Pirani, a graduate of Fraser Health’s Physician Quality Improvement program, formed a multidisciplinary team to:

  • Increase awareness of DDH among clinicians and parents.
  • Create a standardized referral pathway for at-risk newborns.
  • Establish a one-stop Baby Hippy Clinic with ultrasound, orthotics and pediatric orthopedic resources.

As a result of this work, missed ultrasound rates at RCH decreased from 24 per cent in 2017/18 to 1.6 per cent in 2020. In addition, through surveys about the clinic, parents have indicated a high satisfaction with the clinic experience and the overall process.

“Being informed that my 10-week-old daughter had hip dysplasia, to the extent that her one hip was dislocating with normal movement, was terrifying,” says Alyssa Lazzer, a patient partner. “Knowing that the care my daughter is currently receiving will potentially prevent future orthopedic surgery, chronic pain and mobility issues gives me hope.”

Dr. Pirani is now working on sharing and duplicating the success of this program across Fraser Health.

“Dr. Pirani and his team have developed an innovative and family-centric referral pathway which will, with support, ultimately spread across other Fraser Health sites. It is one of the many initiatives aimed to optimize pediatric musculoskeletal care in our communities,” says Vice President of Medicine Dr. Ralph Belle.

If you are interested in spreading the DDH screening initiative to your site, please contact

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