Quarterly Reporting of Computed Tomography Ordering History Reduces the Use of Imaging in an Emergency Department

• Published in: The Journal of emergency medicine 2017-05, Vol.52 (5), p.684-689
• Main Authors: Ehrlichman, Richard, MD, Dezman, Zachary, MD, MS, Klein, Joel, MD, Jeudy, Jean, MD, Lemkin, Daniel, MD, MS
• Format: Article
• Language: English
• Subjects: advanced imaging; Clinical Competence - standards; department operations; Emergency; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - statistics & numerical data; Evaluation Studies as Topic; Humans; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; radiation; Tomography, X-Ray Computed - economics; Tomography, X-Ray Computed - statistics & numerical data; Tomography, X-Ray Computed - utilization; Utilization Review - methods; Utilization Review - statistics & numerical data
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2016.11.014

Abstract Background Computed tomography (CT) is a useful and necessary part of many emergency department (ED) assessments. However, the costs of imaging and the health risks associated with radiation exposure have sparked national efforts to reduce CT ordering in EDs. Study Objective We analyzed CT ordering habits prior to and following implementation of a feedback tool at a community hospital. Methods In this intervention study, we identified the CT-ordering habits of physicians and mid-level care providers (physician assistants and nurse practitioners) at baseline and after implementation of a system that sent quarterly feedback reports comparing their ordering habits with those of their peers. Variability in ordering and subgroup analyses by body region were included in these reports. Results We examined the records of 104,454 patients seen between October 1, 2013 and December 31, 2014. There were 5552 or 21.0% of patients seen during the baseline period that underwent CT imaging. We observed an absolute reduction in imaging of 2.3% (95% confidence interval 1.7–2.8%) after implementation, avoiding approximately $400,000 in costs, 22 days of scanning time, and radiation exposure equivalent to 33,000 chest films annually. These changes occurred across physicians and mid-level providers, regardless of the number years of practice or board certification. Conclusions Implementation of a feedback mechanism reduced CT use by emergency medicine practitioners, with concomitant reductions in cost and radiation exposure. The change was similar across levels of medical care. Future studies will examine the effect of the feedback reporting system at other institutions in our hospital network.