VERIFICA E REVISIONE DELLA QUALITA DELL'ASSISTENZA (VRQ) IN UN SERVIZIO AMBULATORIALE DI ELETTROMIOGRAFIA

With the double aim of improving the quality of service offered and of limiting the management costs of an electromyographic (EMG) outpatient unit, a critical evaluation was made of the requests for EMG issued by the family doctors or specialists of patients referred for this service. The doctor's suspected diagnosis was compared with the patient's objective clinical data and medical history in order to see how necessary an EMG really was in each case. The study focused on the EMG Service of the Outpatient Unit of USL 7, Siena. 1214 EMG requests for patients undergoing this examination for the first time in 1994 were evaluated. 438 requests were excluded from the study: these were from patients requiring EMG for legal purposes, reasons related to pensions or from patients who had already had an EMG in another laboratory. In 76.2% of cases, the referring doctor had indicated the suspected diagnosis in his request. The most frequent suspected diagnoses were: carpal tunnel syndrome 54.3%, radiculopathy of a lower limb 20.4%, radiculopathy of an upper limb 8.4% and polyneuropathy 6.5%. The suspected diagnosis was compatible with the patient's medical history and symptoms in 56.5% of cases. In 23.1%, compatibility could not be evaluated as suspected diagnosis was not indicated. In the other 20.4%, the suspected diagnosis was not plausible. In 77% of cases, the EMG specialist considered the examination useful to confirm the clinical diagnosis. After neurological examination and EMG, the suspected diagnosis was confirmed only in 42% of cases. Analysis of the results in relation to the category of doctors requesting EMG showed that when the request was issued by a neurosurgeon, there was a higher degree of plausibility in the suspected diagnosis and greater utility of EMG than when the request was issued by other specialists or general practitioners. This difference depended on the different distribution of suspected diagnosis among categories of doctors. In order to make the study as objective as possible, and to avoid 'expectation distortions', a second EMG specialist was asked to evaluate the plausibility of the suspected diagnosis and the utility of EMG in each case. There was a highly significant similarity of evaluation. In order to slim down the procedures for PNS disorders and reduce the number of unnecessary EMGs, thereby limiting management costs, the authors suggest that the electromyographist should be allowed the discretion to perform EMG only in patients in whom it is truly necessary to confirm a clinical suspicion, decide appropriate therapy or provide adequate follow-up.