audit of bladder filling for pelvic ultrasound by kumbulani zhou
TRANSCRIPT
AuditAuditofof
Bladder filling for pelvic Bladder filling for pelvic ultrasoundultrasound
byby
Kumbulani ZhouKumbulani Zhou
WhyWhy
continuation of audit cyclecontinuation of audit cycle
last audit October 2004last audit October 2004
commitment to quality scanningcommitment to quality scanning
problemproblem
workflow severely disrupted workflow severely disrupted
time is wasted; for patients & stafftime is wasted; for patients & staff
end up working under pressureend up working under pressure
cannot rule out suboptimal examinationscannot rule out suboptimal examinations
impactimpact
can range from staff inconvinience can range from staff inconvinience to compromised patient diagnosisto compromised patient diagnosis
aimaim
achieve 100% full bladders at achieve 100% full bladders at scanning timescanning time
obviate internal scans where possibleobviate internal scans where possible
increased patient throughputincreased patient throughput
Why full bladderWhy full bladder
•texture of the myometrium to be appreciated and any texture of the myometrium to be appreciated and any
abnormality, e.g. fibroid can be picked up.abnormality, e.g. fibroid can be picked up.
MethodMethod
Patients gently asked about Patients gently asked about instructions and bladder fillinginstructions and bladder filling
Excluded patients brought in scan Excluded patients brought in scan room room ±15min outside appointment ±15min outside appointment timetime
84 patients June-July 200684 patients June-July 2006
ResultsResults
48
36
71
7
0
10
20
30
40
50
60
70
80
full not full read R-advice
No
patie
nts
Series1
CommentsComments read parking instructions onlyread parking instructions only comes every year so she new what was expectedcomes every year so she new what was expected 2 expecting internal scan- Y3 UKCTOCS patient2 expecting internal scan- Y3 UKCTOCS patient thought she needed to starve –abd/pelvisthought she needed to starve –abd/pelvis
One could not get full at all – hot weatherOne could not get full at all – hot weather unable to tolerate very full bladderunable to tolerate very full bladder did not get appointment letterdid not get appointment letter bursting told no one, emptied – filling againbursting told no one, emptied – filling again one patient waited 2h, did not want internal scanone patient waited 2h, did not want internal scan 2 no obvious reason2 no obvious reason
Has bladder filling Has bladder filling improved?improved?
What happened to those who What happened to those who were were
not full?not full?
1
16
20
0 5 10 15 20 25
re-appt
internal
wait 20+
No. patients
Series1
Analysis of the internal Analysis of the internal scansscans
int.-clin.ind. 12
unfilled 4
not want 3
int.-clin.ind. unfilled not want
SuggestionsSuggestions
Fog Index:Fog Index: Score: 8.8 Recommended score:7/8Score: 8.8 Recommended score:7/8 The water must be finished 1h before The water must be finished 1h before
your appointment time.your appointment time. Make sure your bladder is full for the Make sure your bladder is full for the
scanscan You must finish 4 glasses of water at least You must finish 4 glasses of water at least
one hour prior to the procedure.one hour prior to the procedure. Do not empty your bladder.Do not empty your bladder.
SuggestionsSuggestions
Reception:Reception: ask degree of filling on arrivalask degree of filling on arrival
encourage bladder filling straight encourage bladder filling straight awayaway
ascertain extent of filling before pt is ascertain extent of filling before pt is brought into scan room (e.g.tick box)brought into scan room (e.g.tick box)
SuggestionsSuggestions
techniquetechnique:: ? internal only scans? internal only scans PCOs, endometriumPCOs, endometrium ∆ ∆ large pelvic tumours can be large pelvic tumours can be
missed if only internal scans carried missed if only internal scans carried outout
resolution of hfp only good up to 60-resolution of hfp only good up to 60-80mm (www.ebm-guidelines.com)80mm (www.ebm-guidelines.com)
EndEnd
When asked if they feel that their When asked if they feel that their bladder is full, such patients will bladder is full, such patients will show the practitioner the water show the practitioner the water bottle and typically say ‘I have drunk bottle and typically say ‘I have drunk all that’. Some will say ‘I hope so!’ all that’. Some will say ‘I hope so!’
Lerski (1988) and Zaidi (1996) both Lerski (1988) and Zaidi (1996) both agree that an insufficiently filled agree that an insufficiently filled bladder is the cause of a large bladder is the cause of a large number of mistakes in pelvic number of mistakes in pelvic ultrasoundultrasound
It is highly recommended to always It is highly recommended to always reinforce information that had reinforce information that had already been given. No assumption already been given. No assumption should be made that the patient has should be made that the patient has read it.read it.
provide information pertaining to provide information pertaining to importance of full bladderimportance of full bladder,,
correcting any inaccuracies correcting any inaccuracies
Practitioners should not suffer ‘burn Practitioners should not suffer ‘burn out’ from constantly juggling patients out’ from constantly juggling patients
Patients themselves should not suffer Patients themselves should not suffer long waiting times long waiting times