Service Evaluation: Do referrals into the community deep-vein thrombosis ultrasound service meet the agreed criteria?
Emma Mitchell, Hull University Teaching Hospitals NHS Trust
Background
The purpose of this service evaluation was to gain a greater understanding of the community deep-vein thrombosis pathway. The three aims were to evaluate whether incoming referrals met the agreed criteria in the local pathway, to determine the positive detection rate of deep-vein thrombosis in referrals that did and did not meet the agreed referral criteria and to determine the positive pick-up rate of causative pathology in cases of unprovoked deep-vein thrombosis. The referrals were compared against the local agreed criteria which are derived from National Institute for Health and Care Excellence guidelines.
Methods
Retrospective data were collected from a radiology database of lower limb venous ultrasound examinations performed in the community setting from March 2019 to March 2020. A sample size of 500 was collected from a database of 1,800 examinations. Data analysis was performed to calculate difference in percentages, 95% confidence intervals and significance level.
Results
76.2% of referrals met the agreed criteria and 23.8% did not. In 28.5% of cases, rescans were performed. Positive detection rate of deep-vein thrombosis was 9.9% in the referrals that met the criteria and 5.0% in referrals that did not. There was found to be no significant difference between the referrals that did and did not meet the agreed criteria in terms of positive detection rate of deep-vein thrombosis. In cases of unprovoked deep-vein thrombosis, all patients received an abdominal and pelvis ultrasound; however, no causative pathology was found.
Conclusion
This service evaluation found almost a quarter of incoming referrals did not meet the agreed criteria; therefore, sonographers involved in the vetting process require training to reduce poor-quality referrals. No causative pathology was identified by performing an abdominal and pelvis ultrasound in cases of unprovoked deep-vein thrombosis, and this guideline may need review.