1. Assessment Of Adherence To Imaging Recommendations
Made In Emergency Abdominal Ultrasound Examinations
Nishigandha Burute, Ekta Sehgal, Timothy Dowdell,
David MacKinnon, Errol Colak, Anish Kirpalani
St. Michael’s Hospital and University of Toronto
Toronto, Canada
3. Target audience
All individuals involved in patient care particularly
• Radiologists
• Emergency department physicians
• Hospital management and administrative personnel
4. Background
• Radiology reports for emergency department (ED)-referred imaging tests
often contain recommendations for further imaging evaluation.
• Adherence to these recommendations is crucial for continuity of patient
care and may play a significant role in comprehensive patient
management and outcome.
• Adherence may be influenced by patient, pathology and reporting-
related factors. Knowing the impact of these factors may help improve
adherence.
5. Goals and objectives
To quantify adherence to recommendations for follow-up imaging
(RFIs) made in ED-referred abdominal ultrasound (US) examinations,
and to determine the factors that influence this adherence.
6. Methods
Our institutional review board approved this retrospective study.
The final radiological reports of 1404 consecutive ED-referred
abdominal US exams were reviewed and those that contained RFIs
were analyzed.
7. Methods
• Clinical indication, US diagnosis, and RFIs for each scan report were
recorded.
• Adherence was defined as the recommended study being performed.
number of recommended studies being performed x 100
total number of RFIs
• The effects of individual variables on the adherence rate
(A) were assessed.
Adherence rate (A) =
8. Results
Further imaging tests were recommended in 329 / 1404 (23.4%) ED-
referred US reports. There were a total of 355 such RFIs.
• 329 reports had one or more recommendations
• There were a total of 355 recommendations in these 329 reports
329
Reports that had RFIs
9. 1404 total studies
1075 (76.6%) with no
further RFIs
355 RFIs
329 (23.4%) studies with
RFIs
188 (52.9%) follow-up
study performed
167 (47%) follow-up
study not performed
Overall adherence to RFIs = 52.9% for the primary recommendations
Results: RFIs and overall adherence rate
11. Results: Distribution of follow-up studies performed
61
45
31
10
7 6 7
4 4
2
7
4
Most (78.2 %) follow-up studies that were performed were done within 3 days of the
primary scan. This is expected since these are ED referred scans done for acute
conditions.
12. 215
133
18
94
35
57
10 12
A = 61.8 % A = 19.1 % A = 61.4 % A = 83.3 %
Adherence was 83.3% when ERCP was recommended, 61.8% when CT, 61.4%
when MRI, and 19.1% when ultrasound was recommended.
Total
Adhered
Results: Adherence to RFIs by modality
13. 129
188
51
147
A = 68.6 % A = 34.6 %
Adherence was greater when US findings were consistent with the clinical
suspicion than when they were discrepant (68.6% vs. 34.6%, p < 0.0001)
Results: Adherence to RFIs
17. 33
43
5
7
19
31
6
12
14
33
13
32
A = 76.7 % A = 71.4 % A = 61.3 % A = 50 % A = 42.4 % A = 40.6 %
Among acute pathologies, adherence greatest when there was (1) suspected bile
duct dilation/ obstruction and (2) findings of post-surgical complications
Results: Adherence to RFIs
18. Follow-up imaging, when performed, was conclusive in 87.7% cases, indicating
that adherence to recommendations contributes to improved patient care
Conclusive
87.7 %
Further RFI
5.8 % Inconclusive
6.3 %
Results: Analysis of follow-up imaging tests
19. Conclusion
1. In our study, 23.4% of ED-referred abdominal US exams contained
recommendations for follow-up imaging.
2. The adherence rate to these recommendations was 52.9%.
3. When performed, follow-up studies were conclusive in 87.7% of
cases
4. Several factors influenced the adherence rate.
20. Conclusion
Adherence rate was influenced by:
1. Whether the US findings were abnormal or normal
2. Organ system and the type of pathology that was present
3. Whether the US findings were consistent with the clinical suspicion
4. Whether the RFI addressed the clinical suspicion
21. Addressing these factors may be important in the implementation of
quality improvement measures in radiology departments and EDs.
Conclusion
22. • Statistical evaluation: Sidharth Saini
• The research team at St. Michael’s Hospital
Acknowledgements
23. References
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