Emergency doc-led quality initiative cuts $6M in spending on CT at 2 EDs
An emergency medicine-led initiative has helped one health system eliminate thousands of requests for unnecessary computed tomography scans, saving some $6.2 million in the process.
While CT is invaluable for detecting life-threatening injuries in the emergency department, such imaging of the head and cervical spine provides little value for low-risk trauma patients. This can expose individuals to avoidable radiation, increase costs and create inefficiencies in already overburdened EDs, experts write in the Western Journal of Emergency Medicine.
Researchers with University of Cincinnati recently championed a new quality initiative, seeking to address this issue. The UC effort included continuing education sessions, schooling clinicians on when ordering a CT scan provides little value, according to a Sept. 18 news announcement from the school.
“Not everyone with a head or neck injury needs a CT scan. Some do; some don’t,” co-senior author David O. Thompson, MD, MPH, director of quality improvement and patient safety, said in a Friday announcement. “We strive to provide the right care for every patient, and we have the tools to make those decisions.”
UC’s prospective study involved two emergency departments within one healthcare network, including an academic trauma center (UC Medical Center) and community hospital (West Chester Hospital). Thompson and colleagues collected data on baseline CT use for six months, followed by a 23-month intervention period. As part of the project, UC embedded clinical decision-support software—instead of using “hard-stop best practice advisories”—into its electronic health record to help referrers avoid unnecessary requests. Docs received training on using the software (AgileMD) via email and departmental presentations. Researchers also focused on educating patients, and especially those who insisted they needed a CT scan despite their doctor’s determination.
Thompson and colleagues estimated that the practice change led to the avoidance of over 3,500 head and cervical CT scans in a nearly two-year period. At an estimated cost of $1,750 per scan, this results in about $6.2 million in patient healthcare cots saved. In addition, UC was able to avoid about 4 hours of wait time per scan, for a total of nearly 14,200 hours saved. On top of that, patients dodged over 6,000 millisieverts of radiation, while zero patient harm was identified due to the skipped scans.
“We do not miss serious injuries if you follow these guidelines,” said Thompson. “There is no downside. Indeed, we did not find a single missed injury when we reviewed our data.”
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.