Impact of delayed ultrasound scanning

With an ageing population and increasing patient expectations of healthcare, the UK National Health Service is subdueed due to severe financial constraints. In the face of global economic crisis, resources are cut – resulting in hospital Trusts urgently taking the lead to improve efficiency and efficacies. Non-specific abdominal pain and biliary tract disease account for 35% and 5% respectively of surgical admissions in our hospitals in the UK.1 There are many diagnostic tools, which can be used to evaluate cases of rightsided abdominal or pelvic pain, especially in female patients. Ultrasound scan is a popular and sensitive imaging modality as it has many advantages over other imaging techniques. Trans-abdominal ultrasound scanning does not emit any ionising radiation, is non-invasive, safe to use and much less costly than other high resolution scanning – such as computed tomography or magnetic resonance imaging. Furthermore, ultrasound scans sensitively and accurately detect hepatobiliary, renal and pelvic pathology.2 Cochrane et al3 in the late 1990s performed a randomised controlled trial demonstrating that early reporting of trans-abdominal ultrasound scans and plain abdominal radiography by radiologists facilitates in preventing unnecessary surgical admissions.3 However, few studies have demonstrated the clinical and financial impact of delayed ultrasound scanning on admitted surgical inpatients. The aim of this study was to evaluate and highlight the importance of urgent ultrasound scans.

Materials and methods

 Study population: All surgical inpatients, who had transabdominal ultrasound scans performed between May and July of 2005, 2006 and 2007 were retrospectively included. Study design and data collection: Patient details were collected from the computerised hospital database. Information relating to diagnosis, urgency of each scan, length of stay and clinical indication for scan were tabulated for analysis. From this information, time taken for each scan requested (from time of admission to request), the timing of the scan requests (office hours, weekday out-of-hours or weekends) and time taken for each scan performed (from request to exam date) were determined. Furthermore, patients discharged within 24 hours of ultrasound scan were compared with patients who were delayed from discharge as a direct consequence of scan results. The timing of the scan requests was categorised into office hours (9 am to 5 pm between Monday and Friday inclusive), weekday out-of-hours (5 pm to 9 am during the weekdays) and weekends (9 am Saturday to 9 am Monday). These categories were comparable with our radiology department set standards, in line with the duty rota of the consultant radiologists. The set standards were that all noninterventional trans-abdominal ultrasound scans requested before 4:30 pm during the weekday should be performed on the same day, out-of-hours requests should be carried out within 24 hours regardless of the day of the week, and all weekend requests should be completed by the end of Monday. Compliance of our radiology department with regards to transabdominal ultrasound scanning for surgical patients was also evaluated.