Ultrasound

Adult

POAC will fund abdominal ultrasound for:

• Painless jaundice without obvious cause — consider discussing with a secondary care specialist or the Primary Care Radiology Liaison, as a CT scan may be more appropriate
• Suspected gallstones
• Secondary care clinician, Primary Care Radiology Liaison (PCRL) or radiologist advises referral for a same- or next-day ultrasound scan

Paediatric

POAC will fund abdominal ultrasound for:

• Mass or suspected mass on examination — seek paediatric or secondary care advice; if community ultrasound is recommended before hospital review, arrange as an acute same- or next-day scan
• Suspected organomegaly on examination — seek paediatric or secondary care advice; if community ultrasound is recommended before hospital review, arrange as an acute same- or next-day scan
• Secondary care clinician, Primary Care Radiology Liaison or radiologist advises referral for a same- or next-day ultrasound

Acutely unwell — suspected gynaecological cause

• Sudden onset of severe pelvic pain, clinically stable, suspected ovarian torsion or ovarian cyst accident (e.g. rupture or bleed) — within 24 hours
• Ongoing acute pain immediately following ED presentation, referred directly by a hospital clinician

Retained products of conception (RPOC) / endometritis — post miscarriage, TOP or postpartum

Funded where a patient presents with persistent pelvic pain and tenderness (± low-grade fever, ± bleeding), and RPOC is suspected more than 2 weeks after a miscarriage or delivery.

• Bleeding alone within the first 2 weeks following miscarriage or delivery is a normal post-event finding and does not warrant urgent imaging under POAC
• Without pelvic pain or tenderness, arrange a routine ultrasound via Access to Diagnostics (ATD) or eReferral rather than POAC

Lost IUCD strings Within 24 hrs

IUCD strings missing and not visible on examination, or the IUCD breaks on removal and only a fragment is removed — and, in either scenario, the patient has symptoms suggestive of possible perforation, including cramping pain, discharge or unexplained bleeding.

Suspected ectopic pregnancy Within 24 hrs

• POAC will only facilitate and fund the co-payment for a community ultrasound to exclude 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

• Urine hCG greater than 1000 IU on testing at 14 days post-procedure or early medical abortion (EMA), or
• Serial serum bHCG remains high after 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 (a decrease of 80% or more between baseline and follow-up 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 specialty, to rule out a 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 requiring admission, but who do not respond to treatment per the PID guidelines within 3 days (with secondary care endorsement) — see HealthPathways: Pelvic Inflammatory Disease.

Abnormal uterine bleeding

POAC funds ultrasound pelvis for Counties Manukau patients with abnormal uterine bleeding (AUB) or post-menopausal bleeding (PMB), arranged within approximately two weeks. Auckland / Waitematā should be requested via eReferral or Access to Diagnostics.

Adult

• Renal colic where pregnant, or female younger than 35 with uncomplicated renal colic — i.e. a CT KUB and radiation are warranted if there is a history of stones, a solitary kidney, or presentation with haematuria and/or fever
• Pyelonephritis presenting with fever (higher than 38°C), 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 not improving 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 — serum creatinine increase from baseline of more than 50 µmol/L in 7 days, or more than 25 µmol/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 a palpable enlarged bladder
• Secondary care clinician, Primary Care Radiology Liaison or radiologist advises referral for acute renal ultrasound

Paediatric

Funded only where specifically requested by a secondary care specialist or radiology liaison, and required within this timeframe in the community.

Soft tissue — adult

• Suspected foreign body (non-ACC)

Soft tissue — paediatric

• Secondary care clinician, Primary Care Radiology Liaison or radiologist advises referral for a same- or next-day ultrasound

Musculoskeletal — adult and paediatric

• Suspected foreign body (non-ACC)