RT Journal Article
SR Electronic
T1 Appropriate CT cervical spine utilisation in the emergency department
JF BMJ Open Quality
JO BMJ Open Qual
FD British Medical Journal Publishing Group
SP e000844
DO 10.1136/bmjoq-2019-000844
VO 9
IS 4
A1 Mark Baker
A1 Cassie Jaeger
A1 Carol Hafley
A1 James Waymack
YR 2020
UL http://bmjopenquality.bmj.com/content/9/4/e000844.abstract
AB 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.