Reaudit of transvaginal ultrasound practice in a general gynecology clinic

Purpose: A recent pilot audit found that the quality of transvaginal ultrasound practice in a teaching hospital did not reflect current guidelines. This was a concern given the frequency and importance of ultrasound examinations in approaching a diagnosis. Interventional measures involved ad hoc training sessions coincident with installation of updated equipment. A reaudit was performed to assess any changes in the standard of ultrasound practice.

Methods: Data were collected by random direct observation. To minimize the Hawthorne effect, staffs were not made aware of when active data collection took place. Observations of both patients and end user were compared with current guidelines. Data collected maintained the anonymity of users throughout. Practice was graded as: compliant, partially-compliant, or noncompliant. Descriptive statistics were used to demonstrate any change post-intervention.

Results: Observations (n = 48) of completed gynecology ultrasound practice were recorded, and results described as percentage frequencies (%). Image optimization noncompliant rates declined in the reaudit from 65.1% to 41.67% (P = .07) and noncompliant rates of global examination of gynecology decreased from 60.47% to 14.58% (P < .05). Substantial improvements were seen in terms of image annotations (initial audit, 41.9% vs reaudit, 66.67%), and end user examination of bladder, vagina and cervix when indicated (initial audit, 25.6% vs reaudit, 77.08%).

Conclusion: Regular audit, ad hoc ultrasound training sessions and updated ultrasound equipment resulted in considerably improved compliance of transvaginal ultrasound practice in gynecology.