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Appropriate CT cervical spine utilisation in the emergency department
  1. Mark Baker1,
  2. Cassie Jaeger2,
  3. Carol Hafley3,
  4. James Waymack1
  1. 1Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
  2. 2Department of Operations Improvement, Memorial Health System, Springfield, Illinois, USA
  3. 3Midwest Healthcare Quality Alliance, Memorial Health System, Springfield, Illinois, USA
  1. Correspondence to Dr Cassie Jaeger; Hawk.Cassie{at}


Introduction Over 40 000 CT scans are performed in our emergency department (ED) annually and utilisation is over 80% capacity. Improving medical appropriateness of CT scans may reduce total number of scans, time, cost and radiation exposure.

Methods Lean Six Sigma methodology was used to improve the process. A National Emergency X-Radiography Utilisation Study (NEXUS)-based PowerForm was implemented in the electronic health record and providers were educated on the criteria.

Results The rate of potentially medically inappropriate CT C-spine scans decreased from 45% (19/42) to 22% (90/403) (two-proportion test, p=0.002). After the intervention, there was no longer a difference between midlevel providers and physicians in the rate of medically inappropriate orders (19% vs 22%) (two-proportion test, p=0.850) compared with that before the intervention (56% vs 31%) (two-proportion test, p<0.01). Overall rates of CT C-spine scans ordered decreased from 69.3 to 62.6/week (t-test, p=0.019).

Conclusion A validated clinical decision-making tool implemented into the medical record can improve quality of care. This study lays a foundation for other imaging studies with validated support tools with similar potential improvements.

  • emergency department
  • decision support
  • computerised
  • healthcare quality improvement

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  • Contributors MB contributed to the study concept and design, acquisition of data and drafting of the manuscript. CJ contributed to analysis of data, drafting of the manuscript and critical revision of the manuscript. CH contributed to the study concept and design, acquisition of data and study supervision. JW contributed to study concept and design, critical revision of the manuscript and study supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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