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Audit on Access to CTPA, Appropriateness of CTPA Requests and Whether Right Heart Strain was Reported
EP33173
Poster Title: Audit on Access to CTPA, Appropriateness of CTPA Requests and Whether Right Heart Strain was Reported
Submitted on 17 Oct 2020
Author(s): Dr May Ting Tan, Dr Hussein Hassan, Dr Joseph Alex, Dr Deepak Pai
Affiliations: Northern Lincolnshire and Goole NHS Foundation Trust, Diana Princess of Wales Hospital, Scartho Road, Grimsby, DN33 2BA
This poster was presented at BIR Annual Congress 2020
Poster Views: 165
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Poster Information
Abstract: Background:
Pulmonary embolism (PE) is one of the important causes of morbidity and mortality. Computed tomography pulmonary angiography (CTPA) remains the investigation of choice for detecting PE.

Standards:
1. CTPA should be performed and reported within 24 hours of receipt of request [1].
2. British Thoracic Society suggested that only 25% of patients with suspected PE actually have the confirmed disease [2].
3. National Confidential Enquiry into Patient Outcome and Death recommended CTPA report should include the presence or absence of right ventricular strain [3].

Target:
100% of patients with suspected PE should have a CTPA performed and reported within 24 hours and report should include presence of right heart strain.

Methodology:
Retrospective data was searched on PACS from January 2019 to February 2020 (total sample size of 1680). Data exported to excel; RAND formula assigned to each patient to ensure randomisation. Data sorted by RAND formula column from largest to smallest. First 10% (n=168) was selected and all reports were reviewed.

Results:
The percentage of CTPA performed and reported within one working day was 76.19%. Most of the delays were between receipt of request and completion of scan. There were only 10.71% confirmed positive PE on CTPA. The results of the audit showed that there is over-requesting of scans. Alternative diagnoses found on the CTPA included respiratory infection, lung tumour or myocardial infarction.
Only 48.30% of the CTPA report commented on the presence of absence of right heart strain.

Recommended Plan:
Education by teaching referrers/trainees. Appoint radiologist as gatekeeper.
Summary: An audit looking at access to CTPA (whether it is performed and reported within 24 hours of receipt of request), appropriateness of CTPA requests and whether right heart strain was reported as per recommendation by NCEPOD. References: 1. National Institute for Health and Care Excellence, 2019. Pulmonary Embolism. Available at: https://cks.nice.org.uk/pulmonary-embolism [Accessed 31 March 2020].
2. Howard, L., Barden, S., Condliffe, R., Connolly, V., Davies, C., Donaldson, J., Everett, B., Free, C., Horner, D., Hunter, L., Kaler, J., Nelson-Piercy, C., O’Dowd, E., Patel, R., Preston, W., Sheares, K. and Tait, C., 2020. British Thoracic Society Guideline For The Initial Outpatient Management Of Pulmonary Embolism (PE).
3. The National Confidential Enquiry into Patient Outcome and Death, 2019. Know the Score. London.
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