Reshaping the Rules at Hutt Valley DHB

Hutt Valley DHB radiology initiative leads to better use of patients’ time

One of Hutt Valley District Health Board’s latest Reshaping the rules initiatives has streamlined the ordering of duplex scans, leading to better use of patients’ time, more timely referral to vascular services and less duplication.

The Hutt DHB’s radiology department has arranged for a clinical nurse specialist in wound care to have requesting rights for duplex scans, for patients needing vascular services.

Clinical Nurse Manager Karen Blair says when a standard Doppler measuring the ankle brachial pressure index is not able to be completed or for those patients assessed as having arterial insufficiency, there is benefit in having early access to a radiological investigation such as a duplex scan.

“People are referred to our community clinic by District Nurses or by their GP – often because wounds aren’t healing. If they need to go on to Vascular services at Wellington Hospital, we now request a duplex scan in advance, so they can go to their specialist appointment with all the information.

“Previously, patients would be referred to vascular services, and once there would be sent for a scan. They would then have to go back to Wellington Hospital to see the specialist again once the scan was done.”

She says having to go to hospital twice can be a big inconvenience for patients.

“People may have to take time off work, find childcare, or find transport. Having a duplex scan already done when they see the specialist means only one trip to Wellington Hospital is needed, not two. Their condition may also deteriorate while they are waiting for a scan and optimal treatment for their wound/oedema is delayed.”

Karen says the new system of a clinical nurse specialist requesting duplex scans is still being refined.

“We’ve had some requests declined because the radiologist felt another scan – such as a CT angiogram would save time in terms of investigation and provide a more accurate outcome.  We would like to work with vascular towards a criteria for circumstances/conditions and appropriateness for the different methods of imaging.

“We are also considering what is best for the patient within a Choosing Wisely framework. A duplex scan takes 90 minutes and requires a stenographer whilst a CT angiogram can take 14 seconds.

“We’ve got to the point where, yes, it’s a great idea, but are still working on getting the flow just right.”

Reshaping the rules is an initiative led by the DHB’s chief medical officer Sisira Jayathissa. It has aspects of the Choosing Wisely campaign but goes beyond just clinical aspects of care, and looks at anything that might be preventing good patient care.

April 2019