Unnecessary arterial Doppler examination of the legs. Clinical decision rules may help?

Abstract

Health resources consumption depends mainly on physicians prescription habits. We identified reduction of unnecessary prescribed lower limbs arterial Doppler examinations as an area of potential cost control and quality improvement. We designed therefore a screening method based on clinical decision rules derived from epidemiological considerations: study of our records showed that patients with normal clinical examination and low risk factors score could be considered free from arterial disease by clinical grounds only, and that patients with normal clinical examination and very high risk score needed an extensive noninvasive evaluation. By offering a screening clinical examination (needing a working time shorter than a Doppler examination) with short waiting lists, we were able to safely exclude many normal patients from extensive Doppler examination, improving effectiveness by reducing total examination time by 22% and service quality by a Doppler examinations scheduling based on clinical severity judgement.