POAC RADIOLOGY SERVICES
POAC funding is available to provide access to community-based radiology services to avoid acute hospital referral. This service is for investigations required within 24-48 hours, which will assist in clinical management decision-making.
Non-acute X-Ray and USS that do not meet POAC funding criteria, should continue to be referred using Access to Diagnostics, Hospital Radiology e-Referral, ACC, or Private Funding. This includes Auckland/Waitemata AUB pathway scans.
Refer to the below for full clinical criteria, exclusions and information on how to access services.
POAC Funding Exclusions
ACC:
Injury-related investigations should be arranged under ACC funding in the first instance.
POAC will assist with the coordination of ACC-related DVT ultrasounds. These remain under ACC funded with POAC covering co-payment only.
Acute injury-related x-rays may have the ACC co-payment funded where initiated under the St John pathway, Emergency Q voucher, ARC/hospice for portable MS x-ray of immobile patients to determine if admission is required, hospital initiated requests.
MATERNITY:
All pregnancy-related ultrasounds should be referred under maternity funding. POAC funding is available where >2 weeks post miscarriage/termination or >6 weeks postpartum. See more information under Pelvic USS Policy or Maternity Ultrasound Requests.
ROUTINE INVESTIGATIONS:
Urgent or routine investigations are not funded under POAC and can be accessed by eReferral to DHB, Access to Diagnostics, or private funding/insurance.
Clinical Policies and Resources
X-Ray Policies
Community Referral Flowcharts
Hospital Radiology Contact
Seek radiology advice about the appropriate imaging to help:
manage the patient.
clarify the interpretation of prior imaging.
avoid unnecessary specialist appointments or emergency department referrals.
Phone:
Auckland 027 491 9589 or (09) 307 2800
Counties Manukau (09) 276‑0044 ext. 53462
Waitemata 021 874 664 or (09) 486 8920 ext 42771
Options if practice has no ATD budget left and investigation is indicated
Explore the patient's ability to pay.
If imaging is indicated as part of discharge planning or follow-up from previous abnormal results from the hospital, select the "imaging requested by hospital provider" checkbox on the ATD ProExtra form and proceed with the request. (This will be taken into account when the practice's budget use is reviewed.)
If the imaging is not urgent, put the patient on in-practice waiting list and issue the imaging request the following month.
If imaging is required more urgently and your practice is:
not "hard floored" or "on notice", proceed with the ATD ProExtra request. Explain why the imaging is required more urgently.
CT Scans
Head CT
POAC will fund non-injury-related head CT scans where required within 24-48 hours. Neurology Endorsement is required.
Discuss with Neurology SMO, Auckland Hospital.
The name of clinician endorsing must be on the radiology request form.
Mon-Fri 8am-10pm: (09) 307 2800 or (09) 375 3484
After Hours: (09) 307 2800 or (09) 375 3484
Is this injury-related and required acutely?
Refer to Emergency Department (no community-funded CT available)
CT KUB - Renal Colic
POAC fund CT KUB (kidney, urethra, bladder) for Renal Colic:
Red flags - discuss with urology
Temp >38 degrees, peritonitis, creatinine >160/L, known renal disease, risk of kidney failure, solitary kidney
First presentation:
Patient aged 50 years + - straight to CT KUB under POAC
Under 50 years - IM/PR pain relief in the clinic, repeat after 20 mins if required.
If pain does not settle proceed CT KUB under POAC
If pain settles with IM/PR pain relief - check bloods and discharge with analgesia and review as required.
Subsequent presentation/pain does not settle (1-4 days):
Arrange POAC CT KUB (non-contrast), or renal USS if pregnant
POAC funded review within 48 hours or clinically indicated
Notes:
Non-contrast CT KUB only, unless specifically requested by urology
Rule out pregnancy in women of childbearing age prior to referring for CT scan. If pregnant, refer renal USS.
Other CT Scans
f required within 24-48 hours - discuss with the relevant hospital specialty. POAC funding will require a named endorsement.
Ultrasound
DVT Ultrasound
Signs and Symptoms of DVT
AND
Superficial Thrombophlebitis, OR
Pregnancy, OR
Upper Limb (Arm), OR
Wells 2 or more
Elevated D-dimer
Bilateral Limbs:
Requires named haematology endorsement
Delayed Scan > 6 hours:
Clinician should consider anticoagulation - oral rivaroxaban unless contraindicated.
Red Flags:
New symptoms - chest pain, shortness of breath (SOB), Suspected pulmonary embolism (PE). Discuss with haematologist.
Upper Abdo USS (RUQ Pain)
Right Upper Quadrant Pain, suspected Gallstones (4-6 hours fasting required)
IM pain relief in clinic:
Ongoing severe - refer hospital
Partially settled, or settled but markedly abnormal LFTs - POAC-funded Upper Abdo Ultrasound
Pain persistent or recurrent last 1-4 days - POAC-funded Upper Abdo Ultrasound
Fully settled - order bloods and e-Referral or Access to Diagnostics (ATD) referral for non-acute USS
Red Flags:
Suspected cholecystitis, cholangitis, pancreatitis, uncontrolled pain with IM analgesia in clinic - discuss on-call surgical team to consider admission.