Factors That Influence Obstetric Ultrasound Scan Turnaround Time at the Kenyatta National Hospital, Kenya (a Cross Sectional Study)

Abstract

Background: Ultrasound is essential for clinical diagnosis and or management of normal and complicated pregnancies. With the implementation of Managed Equipment Project (MEP) in four national referral hospitals and 94 County hospitals (two in each of the 47 Counties) in Kenya, the technology is widely-used in Antenatal care due to its ability to offer potentially lifesaving information on the etiology of limiting differentials. Ultrasonography reports also guide the management of cases of emergencies during pregnancy and in the early postpartum period. Of importance too is the need to get timely reports in cases of obstetric emergencies as this significantly reduces the complications that may emanate from delayed management of the patients. In Kenya, turnaround time (TAT) for obstetric ultrasound its associated factors are poorly defined. Objective: Determine the turnaround time of obstetric ultrasound and its associated factors at the Kenyatta National Hospital (KNH), Kenya. Methodology: This was a Cross Sectional study at KNH labor ward in Kenya from November 2019 to February, 2020. The study population consisted of pregnant women for whom ultrasound is routinely required at 24 or more weeks gestation. Two hundred and seventy (270) participants were recruited and a questionnaire used to collect data. Trained research assistants observed the activities of consenting patients throughout the process of the ultrasound and documented real-time patient flow time from scheduling of ultrasounds to the receipt of requests by the radiology unit. The time it took to prepare and disseminate written reports was noted. Data analysis was done using version 21 of the Statistical Package for Social Scientists (SPSS) by first computing mean ultrasound wait times. The ANOVA test (with Bonferroni Post Hoc) was used to assess the factors that influence ultrasound wait times at KNH. Results: The median gestation age for the study participants was 34 weeks. A majority of the women in the study, 90 (33.3%) had three children. out of the 270 ultrasound scan requests with documentation about when the scan was done, 231 (86%) had the scans done during the week while the rest (39, 14%) had the scans done during weekends. Most of the scans were done during the day, 144 (53.3%). The median duration between making the request and receipt at the radiology unit was 3.5hr (IQR 0.83-5.0); the median duration for performing the ultrasounds was 0.42hr (IQR 0.33-0.50); the median duration for generation and printing of reports was 1.05hr, (IQR 0.5-1.9) while the median duration for the delivery of the printed reports to the department was 0.5hr (IQR 0.33-1.0). The overall median period of time taken between making the request to the presentation of results to the clinician was 10hr (IQR 5.6- 13.0). A total of 231 (85%) of the scans were performed during the day, while 39 (15%) during the night. The mean TAT for performing the ultrasounds during the week day (8.9hr, sd 4.8) was lower than the mean TAT when the ultrasound was performed during the weekend (9.6hr, s.d 6.1); (F=0.54, p, <0.46). The mean TAT for the ultrasounds that were performed during the day (8.7hr, s.d 4.3) was lower than the TAT for the ultrasounds performed at night (9.5hr, s.d 5.6); (F=1.9, p,0.16). Conclusion: The turnaround time at the KNH maternity is comparatively longer than the recommended times, with the turnaround being shorter when the ultrasounds are done during the day and over the weekend.