Cutting CT overuse for appendicitis: 4 factors that distinguish high-performing hospitals
When it comes to addressing the overuse of CT for pediatric appendicitis cases, four key factors distinguish high-performing hospitals from others, according to new research.
Providers have worked to address this concern in recent years, moving to modalities such as MRI and ultrasound that use less ionizing radiation. However, despite these ongoing efforts, high CT utilization rates are still reported among many health systems, experts wrote in the Journal of Pediatric Surgery.
To unearth ways to address this issue, researchers analyzed data from 42 hospitals taking part in the Pediatric Surgery Quality Collaborative, a volunteer consortium of providers. Their work offers important clues as leaders look to improve results at their own institutions.
“Significant barriers to reducing the use of CT in pediatric appendicitis exist,” Andrew Hu, MD, with the Department of Surgery at Northwestern University’s Feinberg School of Medicine in Chicago, and co-authors concluded. “Efforts are required to equip hospitals to reduce their CT utilization in pediatric appendicitis and persuade leadership to prioritize quality improvement,” they added later.
For their study, Hu et al. compared CT utilization among pediatric providers taking part in the National Surgical Quality Improvement Project in 2019. They also conducted interviews with radiologists, surgeons, emergency medicine physicians and clinical data abstractors at seven organizations with low CT-use rates for appendicitis and six more hospitals struggling to make progress. Four factors bubbled to the surface in distinguishing higher performers from the latter: (1) consistent availability of resources, such as ultrasound techs, pediatric radiologists and MRI machines; (2) presence of and adherence to protocols guiding modality decision making and imaging execution; (3) a culture of interdepartmental collaboration; and (4) the presence of a “radiation reduction champion.”
Many top institutions labeled the fourth item as an integral intervention, with radiologists often serving in this role, buoyed by support from leadership and colleagues, the authors noted. Low performers, meanwhile, struggled with “lackluster collaborative involvement” and encouragement from execs.
“Although one champion led the initiative, their effort was usually supplemented with buy-in and involvement across surgery, radiology, and emergency medicine,” Hu and co-authors reported. “Many high performers discussed previous successful interdepartmental quality improvement initiatives and had a regular cadence of multidisciplinary meetings to discuss progress of priority initiatives.”
Read more about their findings in the pediatric surgery journal here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.