title: A quality improvement initiative to reduce unnecessary follow-up imaging for adnexal lesions.
abstract: Our objective was to improve the quality of pelvic ultrasound reports and decrease the number of physiologic and benign adnexal lesions unnecessarily referred for follow-up. We performed a prospective cohort study of 2 quality improvement interventions: academic detailing with education for the ultrasound radiologists and sonographers, and implementation of a national consensus guideline on adnexal cysts. Our primary quality outcome measure was the proportion of pelvic ultrasound exams in which follow-up was recommended for an adnexal lesion. Baseline data collection in January 2006 identified 252 pelvic ultrasound exams, of which 58 (23%) reported an adnexal lesion and 31 (12%) recommended follow-up. Retrospective review revealed that 17 of 31 (55%) reported adnexal lesions with follow-up recommended were physiologic or benign. After intervention 1, 59 of 214 (28%) pelvic ultrasound exams from January 2008 reported an adnexal lesion, with 18 (8%) recommending follow-up. After intervention 2, 64 of 296 (22%) pelvic ultrasound exams from January 2011 reported an adnexal lesion, with 16 (5%) recommending follow-up. Follow-up recommendations decreased 58% (12% versus 5%, P = .004), with significant increase in the proportion characterized as physiologic or benign (P = .001). Through a quality initiative aimed at appropriate description and follow-up recommendations for adnexal cystic lesions identified at ultrasound, we effectively reduced unnecessary imaging referrals. We conclude that: (1) acceptance of an expert consensus guideline was important to add credibility, (2) accessible image-rich charts are invaluable tools at point of use, and (3) elimination of some unnecessary imaging is under the control of the radiologist.
authors.affiliation: Department of Radiology, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Hui
authors.affiliation: Department of Radiology, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Dawna J
authors.initials: DJ
authors.lastname: Kramer
authors.affiliation: Department of Radiology, Virginia Mason Medical Center, Seattle, Washington; Center for Health Services Research, Virginia Mason Medical Center, Seattle, Washington. Electronic address: craig.blackmore@vmmc.org.
authors.forename: C Craig
authors.initials: CC
authors.lastname: Blackmore
authors.affiliation: Department of Radiology, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: Beverly E
authors.initials: BE
authors.lastname: Hashimoto
authors.affiliation: Department of Radiology, Virginia Mason Medical Center, Seattle, Washington.
authors.forename: David L
authors.initials: DL
authors.lastname: Coy
mesh_terms: D000291:Adnexal Diseases / Q000175:diagnosis*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D058996:Quality Improvement / Q000458:organization & administration*; D011871:Radiology / Q000193:education* / Q000592:standards*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review; D014861:Washington; D055815:Young Adult
keywords: Adnexal cysts; imaging appropriateness; quality improvement