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Closed loop audit studying the appropriateness, safety and follow up of CTKUB requests
EP34215
Poster Title: Closed loop audit studying the appropriateness, safety and follow up of CTKUB requests
Submitted on 05 Nov 2020
Author(s): Navin Nagesh, Basab Bhattacharya
Affiliations: Queen's Hospital Romford
This poster was presented at BIR Annual Congress
Poster Views: 69
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Poster Information
Abstract: The Royal College of Radiologists (RCR) guidelines state that CTKUB investigations should be exclusively for query renal colic and a target positive diagnosis rate between 44-65%.

A closed loop audit of CTKUB requests at a large district general hospital was performed. The first cycle (C1) studied 102 consecutive CTKUB referrals in March 2019 and second cycle (C2) studied 101 patients in October 2019. The clinical question for renal colic only appeared on 74% (C1) and 76% (C2) of requests. Positive diagnosis of renal colic was only reported on 14% (C1) and 16% (C2) of requests. Sub-group analysis of both cycles found that 47 patients were female under the age of 45 had a CTKUB before an abdominal ultrasound. In this population renal colic was only reported in 4% of scans, with gynaecological differentials accounting for the majority of alternative diagnoses. NICE recommend patients over the age of 45 presenting with haematuria should be referred to Urology under the 2 week pathway. However, only 3% of patients in this demographic who had a CTKUB were referred.

Education regarding RCR guidelines and audit findings delivered to radiologists and the ED doctors between C1 and C2. Despite this, CTKUBs continue to be inappropriately requested and patients inadequately followed up. This poses a radiation safety and clinical governance risk. Potential solutions include a separate CTKUB form outlining request criteria and further Urology referral guidelines. Training of ED doctors in abdominal ultrasound imaging may allow patients to obtain an alternative diagnosis before CTKUB is requested.
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