Attitudes toward evidence‐based clinical decision support tools to reduce exposure to ionizing radiation

Abstract

Background and purpose A large degree of variation in clinical practice exists among clinicians evaluating and treating individuals with minor head injuries. Noncontrast head computerized tomography (CT) scans are commonly used to assess for intracranial damage in patients presenting with head injury. This practice is not supported by the evidence and poses harm to patients by increasing exposure to ionizing radiation. This form of radiation exposure increases the risk of developing cancers over the course of the individual's life, and further strains the limited resources of the healthcare system. Project summary This article describes the findings of an evidence‐based practice project assessing the attitudes of clinicians toward an evidence‐based clinical decision support tool (Canadian CT Head Rule [CCHR]). The CCHR has 100% sensitivity in detecting all clinically important brain injuries and any injury requiring neurosurgical intervention. This clinical decision support (CDS) tool is designed to help guide clinicians in the prudent use of head CT scans in people ages 16–64 that have sustained minor head injuries. The Evidence‐Based Attitude Scale was also used to identify which domains were most influential on willingness to adopt into clinical practice. Conclusions The results revealed an 84% increase in clinician knowledge of the use of the CCHR. A majority (83%) of participants reported moderate likelihood of adoption of the CDS tool into clinical practice if they found the tool appealing, and it was required by a governing authority. The use of CDS tools can help healthcare providers mitigate the risk associated with caring for complex patients. CDS tools provide a systematic method to evaluate patients with minor head injuries while assuring consistency of care and quality outcomes. This practice of assuring consistency and good patient outcomes is foundational to the concept of standard of care, which serves to improve clinical practice.

Radiation Exposure in Extracorporeal Life Support

“…Conversely, several tools exist to address medical radiation exposure, including physician education, calculators, etc. 33 Lukoff and Olmos 34 reported that documenting radiation doses as a “vital sign” on electronic medical records can increase visibility and help calculate radiation doses before ordering an imaging test. Also, Yu et al 35 described mitigating radiation exposure by optimizing the technical aspects of CT while steadfastly justifying its clinical need.…”

Improving the Management of Adults With Mild Traumatic Brain Injury

“…Tan et al (2018), who completed a study to evaluate compliance with the CCHR, report that the CCHR has an awareness rate of 31% and a usage rate of 12% in the United States. Other reported factors include local standards of practice, perceived patient expectations, and administrative pressure for higher reimbursement (Tung et al, 2018; Zakhari & Sterrett, 2016).…”

“…Multiple studies also support the use of education to increase awareness and, in turn, increase the use of the CCHR. Zakhari and Sterrett (2016) report an increase in use of the CCHR after the implementation of an intervention to educate providers on its use. Similarly, it was reported that providers were more likely to adopt the tool if it was being successfully used by their colleagues.…”

Reducing Unnecessary Head Computed Tomographic Scans in an Adult Emergency Department

“…16 Studies focused on attitudes and adherence showed that common reasons physicians ordered a head CT scan were to confirm or exclude a diagnosis, fear of missing a diagnosis, and to expedite a diagnosis. 17 Zakhari and Sterrett 18 indicated that clinicians would adopt the CCHR to a moderate extent if they found it appealing and it was required by a governing authority. The greatest barrier to applying the CCHR was the clinician's fear of missing a diagnosis.…”