Reduction in the Number and Associated Costs of Unindicated Dual-Phase Head CT Examinations After a Quality Improvement Initiative

Abstract

1049ward referring clinicians and other health care providers in an effort to optimize patient care in radiology [1,2].In this study, we performed a quality improvement initiative with the goal of reducing the number of unindicated dual-phase head CT examinations by educating referring physicians and radiology faculty about the ACR Appropriateness Criteria. Previous quality initiative studies involving clinical decision support in radiology have focused on either volume reduction [3][4][5] or adherence to ACR Appropriateness Criteria [6,7]. Both approaches have limitations. Quality initiatives that focus explicitly on reducing the number of examinations via utilization management systems often fail to show improved quality of patient care [3][4][5]. Those that focus on adherence to ACR Appropriateness Criteria may result in more appropriate choices of imaging studies, and there-A recent national focus on patient safety and an increasing awareness of the unsustainable expansion of health care costs have served as a rallying cry for the radiology community, which has responded with an increased emphasis on delivering the best possible care to patients in the most efficient manner possible. To achieve and maintain this standard, the American Board of Radiology has mandated systemic practice quality improvement. An important element of practice quality improvement is the American College of Radiology (ACR) Appropriateness Criteria; first developed in 1993, the ACR Appropriateness Criteria provide scientific guidelines regarding the most appropriate use of radiology examinations. The guidelines delineate the best use of radiologic examinations based on evidence-based medicine and are targeted to-OBJECTIVE. During this study, we instituted a phased quality improvement initiative designed to educate referring clinicians and departmental radiologists about the recommendations of the American College of Radiology (ACR) Appropriateness Criteria for dual-phase (without and with contrast material) head CT examinations. The primary aims of the study were to evaluate whether the quality improvement initiative was associated with an improvement in ACR Appropriateness Criteria appropriateness ratings and a reduction in the number of unindicated dual-phase head CT examinations performed. A secondary aim was to assess the impact of the quality improvement initiative on health care costs. MATERIALS AND METHODS.This study included-with the exception of the examinations performed during a 3-month training period-all single-and dual-phase head CT examinations performed of adult patients at a tertiary care medical center from January 2009 through October 2011. Both inpatients and outpatient examinations were included. There were no exclusion criteria.RESULTS. Implementation of the initiative enhanced patient safety and reduced health care costs by achieving a significant reduction (p = 0.006) in the number of unindicated dual-phase head CT examinations performed from a median number of 40 per month to 17 per month.CONCLUSION. Although ...

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