Transvaginal sonography: Sonographer reflections on patient experience using a critical incident technique

A qualitative exploration of sonographers' views toward transvaginal ultrasound in Zimbabwe: A barriers and solutions approach

INTRODUCTION

Given the increasing reliance on pelvic imaging and the superior diagnostic quality of transvaginal ultrasound (TVUS), the British Medical Ultrasound Society emphasizes that all eligible patients should be offered this procedure to ensure the highest standard of care. However, in Zimbabwe, anecdotal evidence indicates a reluctance among sonographers to offer it to patients. This study aimed to understand sonographers' views on the barriers to adopting TVUS and to identify potential solutions.

METHODS

This study employed a qualitative exploratory design using semi-structured interviews. Ten sonographers working in various healthcare institutions in Zimbabwe were recruited in this study. The interviews were transcribed and the qualitative data were managed in NVivo 13 and analyzed using thematic analysis based on the six steps outlined by Braun and Clarke.

RESULTS

The identified barriers to the adoption of TVUS included: i. Training and confidence ii. Patient and cultural-related factors iii. Resource constraints iv. Clinical Engagement v. Financial and Time Considerations. Proposed solutions encompassed 1. Training 2. Awareness 3. Invest in Equipment 4. Policy development.

CONCLUSIONS

The study highlights Zimbabwe's challenges in adopting TVUS, including financial constraints, limited training, and cultural attitudes. To improve TVUS utilization, simulation-based training, increased awareness, and supportive legislation are needed, ultimately improving women's access to high-quality diagnostic care.

IMPLICATIONS FOR PRACTICE

Addressing the identified barriers to TVUS adoption through targeted training, increased awareness, investment in resources, and supportive policies are essential for enhancing women's access to timely and effective diagnostic care.

Australian sonographers' perceptions of patient safety in ultrasound imaging: Part two - translation into practice

Introduction

A lack of patient safety research hampers capacity to improve safety in healthcare.Ultrasound is often considered 'safe' as it does not use ionising radiation, a simplistic view of patient safety. Understanding sonographers' actions towards patient safety is crucial; however, self-reported measures cannot always predict behaviour. This study is part of a PhD exploring patient safety in medical diagnostic ultrasound. The aim of this paper is to explore sonographers' responses to the patient safety concerns identified in Part one of this study. The ultimate aim of the study is to inform the final phase of the doctoral study which will consider the next steps in improving the quality and safety of healthcare experienced by patients.

Methods

A qualitative study using semi-structured, one-on-one interviews. The Theory of Planned Behaviour (TPB) explained how sonographers respond to perceived patient safety risks in practice.

Results

Thirty-one sonographers were interviewed. Based on the seven themes identified in Part one of the study, results showed that incongruences exist between identifying patient safety risks and the actions taken in practice to manage these risks.

Conclusion

The TPB showed that behavioural, normative and control beliefs impact sonographers' responses to perceived patient safety risks in practice and can lead to risk avoidance. Lack of regulation in ultrasound creates a challenge in dealing with Fitness to Practice issues. Collective actions are required to support sonographers in taking appropriate actions to enhance patient safety from multiple stakeholders including accreditation bodies, regulatory authorities, educational institutions and employers.

Patient understanding of diagnostic ultrasound examinations in an Australian private radiology clinic

Purpose

To determine patient understanding and expectations of ultrasound imaging and its safety, sources of examination information and levels of examination anxiety.

Methods

1070 consecutive patients presenting to a private, regional radiology practice in New South Wales, Australia between 16^th May and 14^th June 2019, were invited to complete a survey while waiting for their non-interventional ultrasound examination. The survey included questions on demographic characteristics, knowledge such as examination risks and safety, ultrasound expectations such as dissemination of results, sources of examination information and levels of participant anxiety. Data were analysed using Kruskal-Wallis tests (SPSS v. 25) to determine statistical associations between participant demographic factors, knowledge, anxiety level and the main source of examination information.

Results

A total of 215/1070 (20%) patients voluntarily participated in the study. Most were female (74%, 159/215), with a median (range) age of 55 (18-92) years. Participant's median (range) score of ultrasound imaging knowledge was 3 (0-5) scored out of six and indicated uncertainty regarding the ultrasound procedure, result dissemination and ultrasound safety. Participants with previous personal experience had significantly higher levels of ultrasound imaging knowledge than those whose primary information source was their referring doctor (P = 0.0005) or the internet (P = 0.026). Significantly higher levels of ultrasound examination knowledge were also associated with lower self-reported levels of anxiety (P = 0.002).

Conclusion

Participants had incomplete ultrasound examination knowledge, including misconceptions regarding safety and result dissemination, some of which could be clarified by the sonographer at the beginning of the ultrasound examination.