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An Audit of Compliance with the Royal College of Radiologist’s (RCR) Guidelines for Renal Function Blood Tests Prior to CT
EP30671
Poster Title: An Audit of Compliance with the Royal College of Radiologist’s (RCR) Guidelines for Renal Function Blood Tests Prior to CT
Submitted on 26 Sep 2019
Author(s): Dr Nickeel Patel
Affiliations: Wexham Park Hospital
Poster Views: 225
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Poster Information
Abstract: BACKGROUND: In August 2013, NICE published guidelines to assess patient’s risk factors in non-emergency imaging that required iodinated contrast. NICE noticeably detailed that each patient should be investigated for chronic kidney disease “by measuring eGFR or by checking an eGFR result obtained within the past 3 months.” In contrast to these guidelines, RCR have since published new guidance in 2018 supporting the Royal Australian and New Zealand College of Radiologists approach to investigating a patient’s kidney function prior to CT.

AIM: To assess radiology departmental compliance at Wexham Park Hospital against current guidance by RCR for blood tests prior to having a CT scan. In addition, to evaluate the total costs of this investigation within our set study and determine a possible solution to prevent unnecessary spending by the department and trust.

AUDIT STANDARDS: RCR have advocated the use of guidelines set by the Royal Australian and New Zealand College of Radiologists. Prior to administration of intravenous contrast, an eGFR should only be obtained if the following are found:
1) Known kidney disease (including kidney transplant)
2) Known diabetic
3) Currently taking metformin (due to risk of lactic acidosis)

METHOD: Data for 100 consecutive outpatient CT scans between April and September 2018 were obtained. Using the integrated clinical environment (ICE) application, we were able to determine which scans had prior renal function blood tests. Any identified investigations where then analysed further comparing eGFR and creatinine results with the recommended guidelines conveyed by RCR.

RESULTS: 79 out of 100 patients (79%) had a renal function blood test prior to CT. A closer analysis of the blood tests showed an incidence of 0% in abnormalities of either the creatinine or eGFR.

CONCLUSION: There are no clear guidelines followed by the radiology department prior to outpatient CT scans. Furthermore, none of the creatinine tests performed changed the management of the patients. The price of one renal function test equates to £5.07. If we were to total the number of unrequired blood tests carried out within this study, a sum of £400.53 could have been saved by the trust.

Three solutions were presented and accepted by the radiology department. First step is for the department to now recognise RCR guidelines as new protocol when investigating patients prior to CT. The second step is to alter the ICE requests for CT scans, providing a tick-box criteria of the above guidelines within the request form, so clinicians are aware of the new guidelines. The last proposed soution is for consideration in the near future and involves investing in a point of care (POC) creatinine device, with the cheapest device costing £4,995. An estimated cost of each POC creatinine test cartridge is £3.95 – this is £1.12 cheaper than its serum blood test equivalent, and would make the whole process easy for the patient and department.

Summary: An audit of compliance with the Royal College of Radiologist’s (RCR) guidelines for renal function blood tests prior to CTReferences: 1. Cope LH, Drinkwater KJ, Howlett DC, “RCR audit of compliance with UK guidelines for the prevention and detection of acute kidney injury in adult patients undergoing iodinated contrast media injections for CT”, Clinical Radiology, 72(12), December 2017. Available online at: https://doi.org/10.1016/j.crad.2017.07.002 [Accessed 06/05/2019]

2. National Institute of Clinical Excellence, “Acute Kidney Injury: prevention, detection and management- Clinical guideline [CG169]”, August 2013, Available online at: https://www.nice.org.uk/guidance/cg169/chapter/recommendations#assessing-risk-of-acute-kidney-injury [Accessed 06/05/2019]

3. National Institute of Clinical Excellence, “Diagnostic Assessment Programme- Point of care creatinine tests to assess kidney function before administering intravenous contrast for computed tomography (CT) imaging. Final Scope”, October 2018. Available online at: https://www.nice.org.uk/guidance/gid-dg10024/documents/final-scope [Accessed 06/
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