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SCoR Guidance

Ultrasound examination times

The SCoR is often asked how much time should be allowed for an ultrasound appointment. The question arises most frequently in relation to requests for general medical ultrasound examinations and growth scans in obstetrics.

It is difficult to give a simple answer as there are so many varying factors that can affect how long a ‘general abdominal’ ultrasound examination will take. These include the nature of the local protocols for such examinations, departmental resources, referral source, patient mobility, support available for the scanning session and for how long a particular intensity of work can and should be maintained. The experience of the sonographer is also a factor and newly qualified sonographers will need longer than experienced staff. Additional time will be required if the sonographer is to teach trainees effectively; some providers have successfully introduced dedicated training lists to help facilitate this.

It is recommended that where there is concern about the times allocated for ultrasound appointments, a valid and agreed assessment of ultrasound examination times is undertaken, taking into account the above requirements and the nature, range and scope of examinations carried out in a standard list for the department concerned. All aspects of the examination should be included from the initial patient greeting and consent through to the completion of the final verified report. This should enable reasonable and sustainable examination times to be established in the light of given local circumstances, including the health and safety considerations relating to sonographer Work Related Musculo-Skeletal Disorders (WRMSD). NHS Improvement has previously published a method of assessing examination times in radiology which can be adapted for ultrasound. Details are provided in Appendix 3. This information is now archived but can still be obtained.

In the absence of a valid and agreed assessment of examination times for general medical ultrasound examinations or obstetric growth scans that fully takes into account the local circumstances, the SCoR advises that a minimum of 20 minutes per examination is allocated.

NHS England has published service specifications (2017-2018) for commissioners relating to fetal anomaly screening.  The relevant service specifications are Nos. 16 (combined test) and 17 (18w to 20w 6d fetal anomaly scan)

https://www.england.nhs.uk/wp-content/uploads/2017/05/serv-spec-16.pdf

Page 10: To complete the ultrasound component of this screening strategy, the scan appointment should allocate time to incorporate pre-scan counselling, the ultrasound examination, post-scan counselling and reporting. The time allocation for appointments to meet these requirements is a minimum of twenty (20) minutes.

https://www.england.nhs.uk/wp-content/uploads/2017/05/serv-spec-17.pdf

Page 12:  The ultrasound scan appointment should incorporate pre scan counselling, the ultrasound

examination, post scan counselling and reporting. The time allocation for

appointments to meet these requirements for a singleton pregnancy is a minimum

of thirty (30) minutes and for a multiple pregnancy is forty five (45) minutes.

The National Institute for Health and Clinical Excellence (NICE) has published recommendations for multiple pregnancy (growth) ultrasound examinations.  ‘Multiple pregnancy: The management of twin and triplet pregnancies in the antenatal period ‘ (2011). CG129.  These can be found at:

http://www.nice.org.uk/guidance/cg129/chapter/1-Guidance

Section 1.3.3.4 Thirty minutes is recommended.

The SCoR expects these service specifications and recommendations to be adhered to.

One of the factors that can affect appointment times allowed by providers for ultrasound examinations is the NHS standard tariff. This has only two codes relating to payment to the provider organisation, either an examination of 20 minutes or less or one of more than 20 minutes.  Any Qualified Provider (AQP) contracts will specify increases in tariff arising from local market forces and innovative service delivery as well as any other local variations that apply.

The role of the sonographer is, of course, much wider than undertaking ultrasound examinations and includes the daily management of the ultrasound sessions, reviewing requests, clinical audit (including Screening Support Sonographer duties where applicable),  participation in multidisciplinary team meetings, reporting discrepancy meetings1, service development, contributing to research and teaching.  These activities as well as the scanning itself need to be included in the workplan of each sonographer, and all will impact on the scheduling of appointments.

The timings for ultrasound examinations and the workplans for sonographers also need consideration in relation to the safety of the workforce. There are significant implications for the health and safety of the sonographer workforce if examination times are reduced without assessment of the risks to the workforce of developing or exacerbating work related musculo-skeletal disorders.

Doubling up appointment slots

Where an ultrasound service is experiencing a problem with patients failing to present for their appointments, it should be managed using other methods such as choice of booking for a patient at a time convenient for them, pre-appointment telephone calls or reminder text messaging. These have been shown to be successful in minimising DNAs and, as a result, patients arriving for their appointments are not penalised by having to wait to be seen because of prospective over- booking of appointments. The latter can lead to complaints, adding to the stresses involved in managing the over-booked list. Routine over-booking also makes it more difficult to examine patients who may be referred urgently at short notice and who sonographers need to accommodate.

Advice has previously been available from NHS Improvement on how radiology services (including ultrasound) can be designed and managed to deliver high quality and efficient services, avoid a mismatch between capacity and demand and improve flow.  If this is not done effectively it can lead to situations where inadequate times are allowed for examinations and unacceptable practices such as ‘double booking’ are introduced in order to compensate for DNAs.

Raising concerns

If there are concerns about ultrasound examination times, these should be raised with management. The SCoR has produced guidance on raising concerns at:https://www.sor.org/learning/document-library/raising-concerns-workplace-guidance-sor-members

References

1. Royal College of Radiologists.  Standards for the reporting and interpretation of imaging investigations- second edition (2018)
https://www.rcr.ac.uk/publication/standards-interpretation-and-reporting...

 

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