Reducing emergency department (ED) computed tomography (CT) utilization in women treated for gynecologic cancers

The objective of this quality improvement (QI) project was to decrease the rate of low-value computed tomography (CT) imaging in established gynecologic oncology patients presenting to the emergency department (ED). This was a cohort study with a before and after design that evaluated implementation...

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Bibliographic Details
Published in:Gynecologic oncology 2020-02, Vol.156 (2), p.288-292
Main Authors: Ostby, Stuart A., Evans, Joel G., Smith, Haller J., Boitano, Teresa K.L., Toboni, Michael D., Heimann, Matthew A., Booth, J. Stu, Thomas, Jarred J., Michael Straughn, J.
Format: Article
Language:English
Subjects:
Acute care services
Cohort Studies
Costs of care
CT utilization
Emergency Service, Hospital - standards
Emergency Service, Hospital - statistics & numerical data
Female
Genital Neoplasms, Female - diagnostic imaging
Genital Neoplasms, Female - therapy
Guideline Adherence
Humans
Middle Aged
Quality Improvement
Tomography, X-Ray Computed - methods
Tomography, X-Ray Computed - standards
Tomography, X-Ray Computed - statistics & numerical data
Value based care
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Summary:The objective of this quality improvement (QI) project was to decrease the rate of low-value computed tomography (CT) imaging in established gynecologic oncology patients presenting to the emergency department (ED). This was a cohort study with a before and after design that evaluated implementation of a QI project designed to decrease CT utilization in established gynecologic oncology patients in the ED. The pre-intervention cohort included patients admitted through the ED from 4/1/17 to 5/31/18, while the post-intervention cohort was from 6/1/18 to 5/31/19. The intervention included gynecologic oncology consultation before CT on patients who had imaging within the prior 3 weeks. Details regarding CT, ED length of stay (LOS), and oncologic history were abstracted. The value of CT was determined by consensus from 2 reviewers. Prospective data monitoring evaluated for patient safety. Prior to intervention, there were 129 unique ED encounters in gynecologic oncology patients leading to admission. CT scans were performed in 101 (78.3%) encounters, 57.7% of which were deemed to be of low-value. Following implementation, the CT utilization rate decreased significantly from median monthly rate of 75.2% to 49.1% (p 
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2019.11.024