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)
For information on how to submit a referral to POAC, see HERE
Ultrasound Abdomen - Adult
POAC will fund Abdominal Ultrasound within 24-48 hours for:
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 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.
Carotid Ultrasound - Adult
POAC will fund Carotid Ultrasound within 24-48 hours for:
Suspected TIA AND ALL of the following criteria:
The suspected TIA episode occurred within the last 2 weeks AND
Symptoms are consistent with an anterior circulation TIA AND
The patient:
does not have any high risk indicators or suspicion for underlying dissection
does not have atrial fibrillation at the time of presentation or any symptoms suggestive of a posterior circulation TIA
is not taking anticoagulants
is a potential candidate for carotid endarterectomy
acute stroke specialist assessment is not available
AND any one of the following
Carotid ultrasound in the community has been recommended by a neurologist or stroke specialist.
Completion of the BPACNZ clinical module stroke/TIA tool indicates carotid imaging in the community is appropriate.
BPACNZ clinical module stroke/TIA tool is not available but the patient has been assessed as suitable for being managed in the community, i.e. the patient meets all of the other criteria above.
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 (scan within 24 hrs)
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 wells score is 2 or more with negative d-dimer, discuss with haematology
If delay in scan of greater than 6 hours consider anticoagulation
Ultrasound Pelvis - Adult
POAC will fund Ultrasound Pelvis within 24-48 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)
Ongoing acute pain immediately following ED presentation and referred directly by hospital clinician
Retained Products of Conception (RPOC) / Endometritis — Post Miscarriage, TOP or Postpartum
Ultrasound is funded under POAC where a patient presents with persistent pelvic pain and tenderness (± low-grade fever, ± bleeding), and RPOC is suspected following miscarriage or delivery, more than 2 weeks after the event.
Bleeding alone within the first 2 weeks following miscarriage or delivery is considered a normal post-event finding and does not warrant urgent imaging under POAC.
In the absence of pelvic pain or tenderness, a routine ultrasound should be arranged via Access to Diagnostics (ATD) or eReferral, rather than POAC.
Funding note for RPOC:
Patients within the Maternity funding (Section 88) timeframe ie 6 weeks postpartum, 2 weeks post miscarriage/TOP, POAC will fund the obstetric co-payment only.
Patients outside of the maternity funding timeframe, POAC will fully fund the scan
Lost IUCD strings
IUCD strings missing and not visible on examination, or IUCD breaks on removal attempt and only a fragment is removed, AND in either scenario the patient has symptoms suggestive of possible perforation including cramping pain, discharge, unexplained bleeding.
Suspected Ectopic Pregnancy (within 24 hours):
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 within the required timeframe.
Include the name of the recommending clinician with the clinical notes provided to POAC (see HealthPathways: Pain and Bleeding in Early Pregnancy)
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, 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 do not respond to treatment as detailed in the guidelines for the management of PID (see HealthPathways: Pelvic Inflammatory Disease) within 3 days (with secondary care endorsement)
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 Renal Ultrasound within 48 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
not responding to antibiotics after 72 hours and abscess development is a consideration
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)
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 palpably 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 and required within this timeframe in the community.
Ultrasound Scrotum - Adult
POAC will fund Ultrasound Scrotum within 48 hours for:
Secondary care clinician or Primary Care Radiology Liaison or radiologist advises referral for acute ultrasound (including low suspicion testicular torsion)
Ultrasound Soft Tissue - Adult
POAC will fund Ultrasound Soft Tissue within 48 hours for:
Suspected foreign body (non-ACC)
Ultrasound Soft Tissue - Paediatric
POAC will fund Ultrasound Soft Tissue within 48 hours where:
Secondary care clinician, Primary Care Radiology Liaison or radiologist advises referral for same or next day ultrasound
Ultrsasound Musculoskeletal - Adult and Paediatric
POAC will fund musculosketetal ultrasound required within 48 hours for:
Suspected foreign body (non-ACC)