Duplex ultrasound is the gold standard for diagnosing chronic venous insufficiency (CVI). We aimed to determine the utility of ordering bilateral versus unilateral studies in patients with suspected CVI to determine if there is a resource and time saving potential for Vascular Laboratories through optimization of the venous duplex study ordering process.
A retrospective review of all patients who underwent bilateral lower extremity ultrasound between January 1- December 31, 2016 at the Massachusetts General Hospital Vascular Laboratory was performed. Demographics, indications for ultrasound, comorbidities, time to perform the study, and time to intervention were documented. Data was analyzed using SPSS statistical software.
Over the study period, 13,854 studies were performed in the vascular laboratory; 810 (5.8%) were bilateral venous reflux ultrasounds. Patient demographics and indications for testing are summarized in Table 1. The time allotted for a bilateral study was 2 hours. 79% of the bilateral studies were positive for reflux with 45.7% involving both legs. 35.5% of patients underwent either venous ablation, phlebectomy, and/or sclerotherapy. However, only 5.3% of patients had venous procedures on both legs within one year from ultrasound. Ablations were the most common procedure performed at 56%, followed by phlebectomy (27.6%) and sclerotherapy (16.4%). Overall, 94.7% of patients did not have a procedure performed on both legs within a year and would require a repeat duplex to ensure insurance coverage of future procedures. Performing unilateral versus bilateral scans, our vascular laboratory could save 767 tech hours which could lead to a 5.5% increase in productivity.
The majority (95%) of patients could have had a unilateral venous duplex prior to initial intervention instead of a bilateral duplex. Implementing change and thereby optimizing utilization of resources, 767 technologist hours could be saved resulting in a potential 5.5% increase in productivity of the vascular laboratory.
Brandon Sumpio, Massachusetts General Hospital Fireman Vascular Center