Critical Issues In Vascular Ultrasound: Initiatives To Improve Patient Care
Douglas L. Wooster, MD1, Elizabeth M. Wooster, M.Ed., PhD Candidate1, Mary E. Angelson, BScN1, Varun Kapila, MD1, David M. Williams, MS2.
1Univ of Toronto, Toronto, ON, Canada, 2Medical Univ of South Carolina, Florence, SC, USA.
Objective: To assay quality issues in vascular ultrasound to identify approaches to improved patient care.
Methods: A literature and clinical practice review, as well as an online survey of vascular surgeons, was done to identify critical issues in each of the domains of vascular ultrasound (VUS) (carotid, aortic, peripheral venous, peripheral arterial and renal/mesenteric). Quality improvement (QI) theory was applied to identifying and classifying gaps and assaying QI strategies. Issues with respect to appropriate indications, technical and interpretation protocols and their application were collated to identify common themes. Credentialing and licensing of technologists, specialty training and registration of interpreting physicians and accreditation of facilities were reviewed to identify valid approaches to improving quality of patient care.
Results: There are recognized concerns in all domains. Critical issues cited in the literature include standardization of guidelines and protocols, training and credentialing of technologists and physicians and detail and accuracy of interpretation reports. The clinical review showed: indication appropriateness (54 - 90%), protocol variations with variable carotid detail (12 -22%), errors in technical domains (30%), variable definitions of aorta measurements (17%), calculation of ABI (12 - 33%) and incomplete venous studies (45-62%). Interpretation deficiencies were noted with confusion of carotid velocities and ratios (12%), description of arterial stenosis and relationship of imaging to velocities, ratios and % stenosis and ABI (18%), misleading venous nomenclature (22%) and incomplete reporting of limited venous studies (55%). Licensing and accreditation initiatives have been shown to improve job satisfaction (77%) and consistency of studies but may not improve patient care.
Conclusions: Despite clinically reliable findings from VUS, critical issues exist. A systematic approach with standards and guidelines, consistent application and expectations is suggested.
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