DESCENT: Department evaluation of scrotal imaging considering european and national testicle guidelines

Historically, routine use of ultrasound in managing undescended testes has been contentious, but current guidelines from the British Association of Urological Surgeons (BAUS) and the European Association of Urology (EAU) recommend against its use due to limited clinical value. Inappropriate use of ultrasound can lead to delays in treatment, unnecessary costs, and suboptimal outcomes.

This study aimed to evaluate adherence to BAUS and EAU guidelines within a secondary urology care centre in the UK and implement interventions to align practice with these recommendations.

A retrospective audit was conducted to assess ultrasound use for undescended testes in patients under 16 years of age. Three interventions were implemented sequentially: (1) a departmental email to radiologists and GPs, (2) a GP update poster via email, and (3) a clinical decision support tool embedded within the requesting and reporting system, ICE. Data were collected for four time periods: pre-intervention, after interventions 1 and 2, and following intervention 3. Changes in the number of ultrasound requests and scans performed were analysed using ANOVA and post hoc tests.

The number of ultrasound scans performed per month decreased from a mean of 4.94 in the control period to 0.13 following the third intervention, representing a 97.4 % reduction (p < 0.001). Similarly, the number of requests decreased from a mean of 4.94 to 1.05, a 78.8 % reduction (p < .001). The tool was significantly more effective than educational measures alone (p < .001).

While educational interventions initially improved adherence, they were insufficient to achieve sustained change. The tool provided a definitive solution, integrating guideline education directly into the workflow. Limitations include the study's single-centre design and potential variability in adherence across regions. Nevertheless, the results align with previous literature emphasizing the need for system-level interventions.

This study successfully demonstrated that adherence to BAUS and EAU guidelines can be significantly improved through the implementation of targeted interventions. The tool was the most impactful, leading to substantial cost savings, reduced delays, and enhanced patient outcomes.