Decision‐making in the referral process of sonographers in primary care screening centers
Abstract
Objectives: To explore the decision‐making process (whether or not to refer) of sonographers performing the 20 weeks standard anomaly scan (SAS) in the screening setting. Methods: A survey was sent to SAS‐sonographers; it assessed experience, training, volume, type of practice, perceived difficulty per organ system, feelings after missing anomalies and reasons for uncertainty and doubt concerning referral. Results: The response rate was 50%. Sonographers tend to seek reasons for uncertainty in patient factors and not in their skills or difficulty of the scan. Most mentioned reasons to refer in case of doubt were repeated visualization of a possible abnormality (98%). We hypothesize that the need of repeated imaging of an abnormality might partly explain why some fetal anomalies are still being missed. Sonographers with limited experience and low volume SAS more often revised, referred and asked colleagues for help than experienced sonographers with high volume SAS. In cases of a missed diagnosis, sonographers frequently blamed internal factors (personal failure 71%). Conclusion: Level of experience and volume of SAS influence revision and referral rates. Personal factors seem to play a role in the decision‐making process of screening sonographers. Future research should focus on these personal factors, to optimize screening ultrasound programs. © 2016 John Wiley & Sons, Ltd.
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The assessment of the fetal heart is perceived as the most difficult part of the standard anomaly scan.
“The assessment of the fetal heart is perceived as the most difficult part of the SAS.22”
From The effect of the introduction of the three‐vessel view on the detection rate of transposition of the great arteries and tetralogy of <scp>Fallot</scp> (2018) · cites this paper as [22]
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- Authors
- Oosterhuis, J. J., Gillissen, A., Snijder, C. A., Stiggelbout, A., & Haak, M. C.
- Affiliations
- Leiden University Medical Center (NL)
- Corresponding author
- Haak, Monique C.
- Venue
- Prenatal Diagnosis
- Publisher
- Wiley
- Published
- 2016-05-17
- Volume
- 36
- Issue
- 6
- Pages
- 555-560
- ISSN
- 0197-3851 (ISSN-L)
- 1097-0223
- OpenAlex
- W2337192257
- Cited by
- 4
- References
- 14
- Citations by year
- 2026: 1 · 2022: 1 · 2018: 1 · 2017: 1
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Prenatal Diagnosis (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Ultrasound in Clinical Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Keywords
- referral decisions, prenatal ultrasound screening, fetal anomaly detection, missed diagnosis, sonographer experience, diagnostic uncertainty
- MeSH terms
- Clinical Decision-Making, Adult, Female, Health Personnel, Humans, Male, Middle Aged, Midwifery, Pregnancy, Primary Health Care, Referral and Consultation, Ultrasonography, Prenatal, Young Adult
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