The efficacy of ultrasound referral review for non-specific pelvic symptoms in a single NHS Trust
By Rebecca Stephenson, Hull University Teaching Hospital NHS Trust
Background
This service evaluation aimed to establish if Hospital Trust A are safely and effectively managing premenopausal pelvic ultrasound primary care referrals for vague pelvic pain and dysfunctional vaginal bleeding. The aim was to identify 500 R-cancelled referrals that met the study criteria, establish referral to diagnosis timescales either on US, CT or MRI and calculate what percentage had an US detectable pathology to assess the R-cancel process at Trust A against the BMUS (2021) guidelines.
Methods
A retrospective audit of R-cancelled data from September 2021 to August 2022 was extrapolated from a local radiology information system for analysis, yielding a total sample size of 45 after exclusions. The data were sub-categorised and percentages for referral to diagnosis timescales and US detectable pathologies were calculated. Results Eight (17.8%) of the 45 R-cancelled referrals had an US detectable pathology of varying medical significance, 0% were found to have a malignancy. The average referral to diagnosis timescale was 4.3 months for US, 4.7 months for CT and 1 month for MRI. The mean average referral to diagnosis timescale was 3.3 months with 1% incurring a delay of 2 weeks referral to diagnosis timescale and 99% had no significant delay.
Conclusion
This service evaluation yielded a small sample size and low percentage of US detectable pathologies which indicates that Trust A has a well-established, safe and effective local R-cancel system in place. A larger audit of sonographer vetting skills specific to premenopausal US pelvis referrals from primary care may further support this. To aid the referrer and provide simplicity to the gynaecology referral criteria, the introduction and development of a Rapid Diagnostic Service at Trust A, specific to gynaecology could be considered in accordance with BMUS (2021) recommendations.