An evaluation of carotid artery ultrasound imaging at a testing facility in St. John's, Newfoundland and Labrador, an design of an electronic test ordering solution to improve access to testing

Chisholm, Nora C. (2020) An evaluation of carotid artery ultrasound imaging at a testing facility in St. John's, Newfoundland and Labrador, an design of an electronic test ordering solution to improve access to testing. Masters thesis, Memorial University of Newfoundland.

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Abstract

Objective To determine volume, clinical characteristics, appropriateness of, and time-to-access carotid artery ultrasound (U/S) testing; and, to describe requirements for an electronic ordering solution. Background Carotid artery disease is a cause of stroke and transient ischemic attack (TIA). Carotid imaging is urgently required in patients with recent neurological symptoms arising from the carotid territory to diagnose critical stenosis and eligibility for carotid revascularization. Methods Utilization of carotid artery U/S testing in adults at the vascular laboratory operated by Eastern Health was evaluated. In phase I, data from 2007-19 were analyzed for incidence of testing, clinical characteristics of the tested cohort, appropriateness of testing, and time-to-access testing. Phase II interventions were aimed at improving access to testing. Phase III involved documentation of learnings into requirements for an electronic test-ordering solution. Results 22,167 adults were tested. 35% of testing was for appropriate reasons and 29% resulted in a diagnosis of critical carotid disease. Prediction of clinically significant stenosis using referral data was poor. At baseline, time-to-access testing was prolonged and 85% of incoming requisitions were defective (unable to triage). Following interventions, mean time-to-access was reduced for highest priority referrals and referral quality improved to a 23% defect rate. Conclusions Although improved access to testing and referral quality were observed with enhancements to the ordering requisition, streamlined triage and scheduling processes, and knowledge translation initiatives, time-to-access was not optimal in patients with recent neurological events. Learnings informed the design of an electronic ordering solution aimed at improving access for highest priority patients.

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