Worth It or Wasteful? Improving Renal Ultrasound Utilization for Patients with Recent Cross-Sectional Imaging

Purpose: Renal ultrasound (RUS) is a non-radiative, low-cost modality used to work up acute renal pathologies, but over-use leads to expenditure of cost, time, and resources. For patients with recent cross-sectional imaging (CSI) including abdominopelvic CT or MRI, obtaining RUS may not provide clinical value. This study evaluates the utility of RUS in inpatients who have undergone CSI within the last 48hrs and determines the efficacy of certain interventions in optimizing RUS use.

Methods/Materials: Electronic medical records were reviewed for inpatients with a RUS ordered during pre- & post-intervention periods. Whether CSI was performed within the last 48hrs, study indication, ordering department, and clinical benefit were recorded. Intervention involved ultrasound technologist (UST) screening of RUS orders to identify pts with CSI performed within the last 48hrs, followed by discussion with ordering team regarding test benefit, and cancellation if low-yield. Follow-up intervention was a best-practice advisory (BPA) tool that notifies of recent CT/MRI, and confirms the provider’s decision to place the order.

Results: 9.04% (19/210) of RUS orders in the pre-intervention group (n=210) were for pts who had undergone CT/MRI CSI in the past 48hrs; 100% of these were for indications already answered on previous imaging. Once implemented, 6.02% (43/714) of orders in the post-intervention group (N=714) were for pts with recent CSI. Of the orders for those with recent imaging (N=43), only 32.56% provided benefit, while 67.44% were for indications already answered on previous CSI. 62.79% of these RUS/CSI orders in the post-intervention group were placed by internal medicine department providers. Thus with UST intervention, the percentage of RUS orders for pts with recent CSI decreased from 9.05% to 6.02% (p=0.12). In the first month of BPA use, 34.5% of RUS orders were canceled after BPA was triggered.

Conclusions: UST screening of RUS orders for pts with recent CSI and discussions with ordering providers for cancellation shows benefit in reducing excess RUS studies, though not statistically significant. Given preliminary data, a BPA tool automatically alerting ordering providers of recent CSI also exhibits benefit.