POAC FUNDED ULTRASOUND
Auckland | Waitematā | Counties Manukau
Principles of funding: POAC will fund the following community ultrasounds:
Where required within 24-48 hours, AND
It is safe to manage the patient in the community, AND
The result of the ultrasound will inform immediate clinical management, AND
The condition is not related to trauma or accident (unless specifically outlined below)
How to Refer
Submit referral using the POAC PMS form, email radiology request form to referral@poac.co.nz, call (09) 535 7218 (Mon-Fri 8am-4.30pm) OR submit using online radiology form here
POAC coordinators will arrange during normal business hours and contact the patient to confirm appointment details
For more details on how to refer click here (TO BE ADDED)
Ultrasound Abdomen - Adult
POAC will fund Abdominal Ultrasound within 24-48 hours for:
Painful jaundice
Painless jaundice without obvious cause - consider discussing with secondary care specialist or Primary Care Radiology Liaison as a CT scan may be more appropriate.
Suspected gallstones
Secondary care clinician or Primary Care Radiology Liaison (PCRL) or radiologist advises referral for same or next day ultrasound scan.
Ultrasound Abdomen - Paediatric
POAC will fund Ultrasound Abdominal within 24-48 hours for:
Mass or suspected mass on examination – seek paediatric or secondary care advice and if community ultrasound is recommended prior to hospital review, arrange as an acute same or next day scan
Suspected organomegaly on examination - seek paediatric or secondary care advice and if community ultrasound is recommended prior to hospital review, arrange as an acute same or next day scan
Secondary care clinician or Primary Care Radiology Liaison or radiologist advises referral for same or next day ultrasound
Ultrasound Breast - Adult
POAC will fund Ultrasound Breast within 24-48 hours for:
Breast ultrasound for bacterial mastitis to rule out collection is funded through POAC when there is no presumptive diagnosis of breast abscess, but the breast remains enlarged, reddened, and painful following 48 hours of oral antibiotic therapy.
Note: There is no need to routinely arrange a breast ultrasound for a clinically obvious breast abscess or suspected galactocele before referring in for further investigation, aspiration, or drainage.
Ultrasound Carotid - Adult
POAC will fund Carotid Ultrasound within 24-48 hours for:
Suspected TIA where presentation with typical symptoms only, the patient is not in atrial fibrillation nor on anticoagulants and
episode occurred within last 2 weeks AND
symptoms consistent with anterior circulation (carotid territory) TIA including language dysfunction and/or limb weakness (and absence of diplopia or ataxia without significant limb weakness, which suggest posterior circulation events) AND
patient is a potential candidate for carotid endarterectomy AND
acute stroke specialist assessment is not available AND one or more of
Carotid imaging recommended by Health NZ neurologist or stroke specialist.
Completion of the BPAC TIA decision support tool indicates carotid imaging is appropriate.
BPAC decision support tool not available but patient assessed as suitable for being managed in the community i.e. all of these apply.
Ultrasound DVT - Adult
POAC will fund Ultrasound DVT within 24-48 hours where suspected DVT and any of the following apply:
Superficial venous thrombosis affecting the proximal long saphenous vein in the thigh
Clinically suspected upper limb DVT
Suspected DVT in pregnancy
Wells score 2 or more
Elevated d-dimer
Same day DVT US recommended by Health NZ Haematology service or other secondary care specialist
Note:
Injury related DVT investigations should be put under ACC for funding purposes. POAC will coordinate the scan and cover the ACC co-payment.
If delay in scan of greater than 6 hours consider anticoagulation
Ultrasound Pelvis - Adult
POAC will fund Ultrasound Pelvis within 24 hours for:
Patients acutely unwell from a suspected gynaecological cause including:
sudden onset of severe pelvic pain, clinically stable and suspected ovarian torsion or ovarian cyst accident (e.g. cyst rupture or bleed)
possible endometritis from RPOC (retained products of conception) in women with persistent pelvic pain and tenderness, +/- low grade fever, +/- bleeding; where the patient is outside the two week post miscarriage maternity-funded scan window. (POAC will coordinate those within the maternity timeframe to ensure timely access)
IUCD strings missing and not visible on examination, or IUCD breaks on removal attempt and only a fragment is removed, and the patient presents with symptoms suggestive of possible perforation including cramping pain, discharge, unexplained bleeding.
Suspected Ectopic Pregnancy:
POAC will only facilitate arrangements and fund co-payment for a community ultrasound for the purpose of excluding ectopic pregnancy IF it has been discussed with and approved by a hospital Gynaecologist, AND an appointment can be arranged the same day.
Include the name of the recommending clinician with the clinical notes provided to POAC (see HealthPathways: Pain and Bleeding in Early Pregnancy)
POAC will fund Ultrasound Pelvis within 48 hours for:
Suspected ongoing pregnancy more than 14 days post abortion and either:
Urine HCG is greater than 1000 IU on testing at 14 days post-procedure or early medical abortion (EMA) OR
Serial serum bHCG remains high after early medical abortion (EMA) especially if bHCG has increased between a baseline test done within 72 hours of Mifepristone and a follow-up test 8-16 days after ingestion (N.B. a decrease in serum bHCG of 80% or more between baseline and follow-up tests excludes ongoing pregnancy).
+/- Ongoing symptoms of pregnancy (e.g. nausea, breast tenderness)
Suspected Pelvic Collection Post Surgery
After discussion with and endorsement by the relevant speciality, POAC will fund an acute ultrasound to rule out suspected pelvic collection
Suspected pelvic collection related to PID:
Patients with symptoms and signs suggestive of pelvic infection who do not have an acute abdomen or sepsis necessitating admission but either:
Do not respond to treatment as detailed in the guidelines for the management of PID (see HealthPathways: Pelvic Inflammatory Disease) within 3 days; or
Have findings on examination suggestive of adnexal mass (relevant findings must be documented)
Ongoing acute pain following ED presentation and referred directly by hospital specialist
Abnormal Uterine Bleeding:
POAC funds Ultrasound Pelvis for Counties Manukau patients for Abnormal Uterine Bleeding (AUB) or Post Menopausal Bleeding (PMB) - see further information here. These are arranged within approximately two weeks.
Auckland/Waitemata US Pelvis should be requested via eReferral or Access to Diagnostics.
Ultrasound Renal - Adult
POAC will fund Ultrasound Renal within 24 hours for:
Renal colic if pregnant or female younger than 35 years old and uncomplicated renal colic i.e. CT KUB and radiation warranted if history of stones or solitary kidney or presents with haematuria +/or fever
Pyelonephritis where presentation with fever (higher than 38 degrees), pyuria on microscopy, loin pain or tenderness, +/- lower UTI symptoms and one of o not responding to antibiotics after 72 hours and abscess development is a consideration o flank pain that does not improve within 24 hours of IV or 48 hours of oral antibiotics (consider CT KUB instead of renal US to look for stones)
POAC will fund Renal Ultrasound within 48 hours for:
Acute renal function deterioration - acute increase of the serum creatinine level from baseline of more than 50 micromol/l in 7 days or more than 25 micromol/L in 2 days - Discussion with secondary care specialist or primary care radiology liaison recommended
Suspected chronic urinary retention e.g. new onset incontinence with palpable enlarged bladder
Secondary care clinician or Primary Care Radiology Liaison or radiologist advises referral for acute ultrasound renal
Ultrasound Renal - Paediatric
POAC will fund Ultrasound Renal within 24-48 hours only where specifically requested by secondary care specialist or radiology liaison where required within this timeframe in the community.
Ultrasound Scrotum - Adult
POAC will fund Ultrasound Scrotum within 24-48 hours for:
High suspicion of testicular cancer (e.g. rapidly growing mass, non-transilluminating, not able to distinguish the mass from the testis, painless)
Secondary care clinician or Primary Care Radiology Liaison or radiologist advises referral for acute ultrasound (including low suspicion testicular torsion)
Ultrasound Soft Tissue - Adult and Paediatric
POAC will fund Ultrasound Soft Tissue within 24-48 hours for:
Suspected foreign body (non-ACC)
Ultrsasound Musculoskeletal - Adult and Paediatric
POAC will fund musculosketetal ultrasound required within 24-48 hours for:
Suspected foreign body (non-ACC)