An Audit on the Appropriateness and Accuracy of Information Provided on Ultrasound (US) Requests in the Deep Venous Thrombosis (DVT) Service for Suitable Vetting and Justification

Assessing the accuracy and appropriateness of information provided by clinicians on DVT US requests to guide suitable vetting and justification by sonographers and/or radiologists

NICE guidelines for DVT provide a clear framework directing patients to have an US depending on Wells score and D-dimer, CG:144 [1]. Accuracy of clinical details is essential to streamline vetting and justification of scans which allows the patient to be accurately allocated to the ‘Likely’ or ‘Unlikely’ DVT pathway. [1,2] Inadequate information causes inappropriate and unneccesary scans to be performed in an already overly-burdened NHS DVT US service [1,2].

The standard: 

Every DVT US request should have

 -a specific clinical question/s provided [2],

 - sufficient information to support the suspected diagnosis [2],

 - D-dimer status [1]

 - Wells score [1]

Target: 

100% compliance in which all DVT US requests should have

 -  specific clinical question 

 - sufficient information to support the suspected diagnosis

 - D-dimer status 

 - Wells score recorded. [1,2]

Indicators: 

Information provided on request

a) Specific clinical question(s) to answer [2]

b) Sufficient information to support the suspected diagnosis(es). [2]

c) D-dimer status [1]

d) Wells score [1]

Data items to be collected: 

Imaging request details obtained from PACS for specific clinical question provided and clinical information provided regarding suspected diagnosis(es)

D-dimer levels obtained from relevant pathology database.

Documented Wells score obtained from relevant recorded database e.g. PACs request, DVT nurses documentation.

Suggested number: 

50 ultrasound studies

Include automated questions for D-dimer status, Wells score and optional risk factors as mandatory information required to request DVT US on clinical request system

Re-educate referrers and DVT services

Re-audit in 12 months

• Computer records

• Radiologist and/or sonographer and/or radiology/DVT service secretaries: 3 - 8 hours data collection and analysis

1. National Institute for Health and Care Excellence (NICE). CG144: Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. https://www.nice.org.uk/Guidance/cg144 (accessed 7 October 2017). 

2. Society and College of Radiographers and British Medical Ultrasound Society. Guidelines For Professional Ultrasound Practice. 1) https://www.sor.org/sites/default/files/document-versions/ultrasound_guidance.pdf (accessed 7 October 2017).

Dr Natasha Davendralingam

Co-authors

Dr Natasha Davendralingam

Dr Meneka Kanagaratnam

Dr Lauren Scarlett

Dr Peter K MacCallum

Dr Emma Friedman