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Audit of the effect of introducing local guidelines for referral for carotid duplex scanning
R J Holdsworth1, J S Bryce, P T McCollum
1Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee.
Insights
Implementing new guidelines for carotid duplex scanning reduced unnecessary referrals by 19%. This improved appropriateness without affecting the detection rate of critical carotid artery disease.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Health Services Research
Background:
- Carotid duplex scanning is a key diagnostic tool for cerebrovascular disease.
- Previous referral criteria for carotid duplex scans were broad, potentially leading to overuse.
- The need for evidence-based guidelines to optimize diagnostic imaging utilization was recognized.
Purpose of the Study:
- To evaluate the impact of introducing specific referral guidelines for carotid duplex scanning.
- To assess changes in referral rates and the appropriateness of scan requests.
- To determine if guideline implementation affected the detection of clinically significant carotid artery disease.
Main Methods:
- Introduction of new referral guidelines specifying indications for carotid duplex scans (hemispheric symptoms or asymptomatic bruits).
- Retrospective analysis of referral data before and after guideline implementation (1994 vs. 1995).
- Comparison of referral rates, proportion of inappropriate requests, and detection rates of occult asymptomatic disease.
Main Results:
- A 19% reduction in the overall referral rate for new carotid duplex scans was observed within one year.
- The proportion of inappropriate requests significantly decreased from 27.6% in 1994 to 12.8% in 1995.
- No significant change was noted in the number of patients identified with asymptomatic carotid artery disease potentially requiring surgical intervention.
Conclusions:
- The introduction of clear referral guidelines effectively reduced unnecessary carotid duplex scans.
- Guideline implementation improved the appropriateness of referrals without compromising the identification of patients with significant carotid disease.
- Evidence-based criteria enhance diagnostic imaging efficiency in vascular care.
Abstract:
Guidelines for referral of patients for carotid duplex scanning were introduced stating that scans were only indicated for patients with hemispheric localising symptoms or asymptomatic bruits. A 19% reduction in referral rate was seen for new scans in a one year period. The number of "inappropriate" requests fell from 27.6% in 1994 to 12.8% in 1995. There was no reduction in the numbers of patients identified with effectively occult asymptomatic disease who may have been suitable for surgery in the same period. Guideline introduction had the effect of reducing unnecessary scans without any effect on the overall pick-up, rate for carotid disease.