Effect of a preauthorization policy on the utilization rate of after-hours emergency department neuroradiology computed tomography

ABSTRACTObjective:To evaluate the impact of an emergency department (ED) automatic preauthorization policy on after-hours utilization of neuroradiology computed tomography (CT).Methods:All CT studies of the head with contrast facial bones, orbits, spine, and neck requested through the ED and performed between January 1, 2004, and December 31, 2010, were reviewed. The preauthorization policy was instituted on February 25, 2008. A control group of noncontrast CT head studies was used for comparison. Pre- and postpolicy implementation utilization rates were compared between the control group of noncontrast CT head studies and the study group neuroradiology CT studies.Results:During the study period, 408,501 ED patient visits occurred and 20,703 neuroradiology CT studies were carried out. The pre- and postimplementation groups of noncontrast CT head scans totalled 7,474 and 6,094, respectively, whereas the pre- and postimplementation groups of all other neuroradiology CT studies totalled 3,833 and 3,302, respectively. The CT utilization between the two groups did not differ significantly: the noncontrast head group pre- and postpolicy implementation increased by 0.31 to 3.41%, whereas the utilization of all other neuroradiology CT studies increased by 0.22 to 1.84% (pvalue = 0.061 for a difference between groups).Conclusion:Implementation of an automatic preauthorization policy for after-hours neuroradiology CT studies did not result in a statistically significant increase in CT utilization. This suggests that concerns regarding the negative effects of such policiesmay be unfounded, and further research in this area is warranted.

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The Impact of a Preauthorization Policy on the After-hours Utilization of Emergency Department Computed Tomography Imaging

Academic Radiology ◽

10.1016/j.acra.2015.11.016 ◽

2016 ◽

Vol 23 (5) ◽

pp. 588-591 ◽

Cited By ~ 3

Author(s):

Kirsteen R. Burton ◽

Raymond L. Lawlor ◽

Deljit Dhanoa

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Computed Tomography Imaging ◽

Tomography Imaging ◽

After Hours ◽

The Impact

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Computed Tomography Use for Adults With Head Injury: Describing Likely Avoidable Emergency Department Imaging Based on the Canadian CT Head Rule

Academic Emergency Medicine ◽

10.1111/acem.13061 ◽

2017 ◽

Vol 24 (1) ◽

pp. 22-30 ◽

Cited By ~ 23

Author(s):

Adam L. Sharp ◽

Ganesh Nagaraj ◽

Ellen J. Rippberger ◽

Ernest Shen ◽

Clifford J. Swap ◽

...

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Head Injury ◽

Ct Head

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THE IMPACT OF HEAD POSITIONING ON THE IMAGE QUALITY OF MULTI-DETECTOR COMPUTED TOMOGRAPHY

Biomedical Engineering Applications Basis and Communications ◽

10.4015/s1016237221500502 ◽

2021 ◽

pp. 2150050

Author(s):

Yang-Ting Hsu ◽

Jo-Chi Jao

Keyword(s):

Computed Tomography ◽

Image Quality ◽

Control Group ◽

Ct Scanner ◽

Head Ct ◽

Radiologic Technologists ◽

Head Positioning ◽

The Impact ◽

Multi Detector Computed Tomography

Radiologic technologists face various types of patients during multi-detector computed tomography (CT) examinations. In emergency departments, it is common to have patients who cannot follow instructions for the examinations. The asymmetric axial view of the head CT might affect the correctness of the clinician’s diagnosis. This study aimed to assess the impact of head positioning on the image quality of head CT using two phantoms. All scans were performed on a 16-slice CT scanner. In the control group, the tilted angle of the phantoms was 0[Formula: see text], and no multiplanar reconstruction (MPR) was performed. In the experimental groups, the tilted angles of the phantoms were 5[Formula: see text], 10[Formula: see text] and 15[Formula: see text], respectively, and MPR was performed afterwards. The results showed that if the head was tilted during the head CT examinations, image asymmetry and artifacts appeared without MPR. After MPR, one phantom showed that there were significant differences and the other phantom showed no significant differences quantitatively in image symmetry and artifacts between experimental groups and the control group, while both phantoms showed no significant differences qualitatively in image symmetry and artifacts between experimental groups and the control group. Although MPR can correct the image asymmetry and artifacts caused by tilted head positioning to some extent, it consumes time. Therefore, technologists should position the head as exactly as possible when performing head CT examinations.

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212 The Impact of Physician Risk Tolerance and Attitudes Toward Clinical Decision Rules on Head CT Utilization for Trauma Patients in the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2011.06.241 ◽

2011 ◽

Vol 58 (4) ◽

pp. S248-S249 ◽

Cited By ~ 1

Author(s):

J.E. Andruchow ◽

A. Raja ◽

R. Zane ◽

L. Prevedello ◽

R. Khorasani

Keyword(s):

Emergency Department ◽

Decision Rules ◽

Clinical Decision ◽

Risk Tolerance ◽

Trauma Patients ◽

Clinical Decision Rules ◽

Head Ct ◽

Ct Utilization ◽

The Impact

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Computed tomography for non-traumatic headache in the emergency department and the impact of follow-up testing on altering the initial diagnosis

Emergency Radiology ◽

10.1007/s10140-015-1314-9 ◽

2015 ◽

Vol 22 (5) ◽

pp. 521-525 ◽

Cited By ~ 4

Author(s):

Jeffrey S. Quon ◽

Rafael Glikstein ◽

Christopher S. Lim ◽

Betty Anne Schwarz

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Initial Diagnosis ◽

The Impact

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Reduction of paediatric head CT utilisation at a rural general hospital emergency department

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-010322 ◽

2020 ◽

Vol 29 (11) ◽

pp. 912-920

Author(s):

Jeffrey Paul Louie ◽

Joseph Alfano ◽

Thuy Nguyen-Tran ◽

Hai Nguyen-Tran ◽

Ryan Shanley ◽

...

Keyword(s):

Emergency Department ◽

Head Injury ◽

Rural Community ◽

Emergency Departments ◽

Control Charts ◽

Intervention Period ◽

Head Ct ◽

Pediatric Injury ◽

Ct Utilization ◽

Ct Head

BackgroundBlunt head injury is a common pediatric injury and often evaluated in general emergency departments. It estimated that 50% of children will undergo a head computed tomography (CT), often unnecessarily exposing the child to ionizing radiation. Pediatric academic centers have shown quality improvement (QI) measures can reduce head CT rates within their emergency departments. We aimed to reduce head CT utilization at a rural community emergency department.MethodsChildren presenting with a complaint of blunt head injury and were evaluated with or without a head CT. Head CT rate was the primary outcome. We developed a series of interventions and presented these to the general emergency department over the duration of the study. The pre and intervention data was analysed with control charts.ResultsThe preintervention and intervention groups consisted of 576 children: 237 patients with a median age of 8.0 years and 339 patients with a median age of 9.00 years (p=0.54), respectively. The preintervention HCT rate was 41.8% (95% CI 35.6% to 48.1%) and the postintervention rate was 27.7% (95% CI 23.3% to 32.7%), a decrease of 14.1% (95% CI 6.2% to 21.9%, p=0.0004). During the intervention period, there was a decrease in HCT rate of one per month (OR 0.96, 95% CI 0.92 to 1.00, p=0.07). The initial series of interventions demonstrated an incremental decrease in HCT rates corresponding with a special cause variation.ConclusionThe series of interventions dispersed over the intervention period was an effective methodology and successfully reduced HCT utilisation among children with blunt head injury at a rural community emergency department.

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Multicomponent exercise program in older adults with lung cancer during adjuvant/palliative treatment: A secondary analysis of an intervention study

The Journal of Frailty & Aging ◽

10.14283/jfa.2021.2 ◽

2021 ◽

pp. 1-7

Author(s):

N. Martínez-Velilla ◽

M.L. Saez de Asteasu ◽

R. Ramírez-Vélez ◽

I.D. Rosero ◽

A. Cedeño-Veloz ◽

...

Keyword(s):

Lung Cancer ◽

Older Adults ◽

Emergency Department ◽

Palliative Treatment ◽

Secondary Analysis ◽

Exercise Programme ◽

Control Group ◽

Post Intervention ◽

Frailty Status ◽

The Impact

Background: Lung cancer is the second most prevalent common cancer in the world and predominantly affects older adults. This study aimed to examine the impact of an exercise programme in the use of health resources in older adults and to assess their changes in frailty status. Design: This is a secondary analysis of a quasi-experimental study with a non-randomized control group. Setting: Oncogeriatrics Unit of the Complejo Hospitalario de Navarra, Spain. Participants: Newly diagnosed patients with NSCLC stage I–IV. Intervention: Multicomponent exercise programme that combined resistance, endurance, balance and flexibility exercises. Each session lasted 45–50 minutes, and the exercise protocol was performed twice a week over 10 weeks. Measurements: Mortality, readmissions and Visits to the Emergency Department. Change in frailty status according to Fried, VES-13 and G-8 scales. Results: 26 patients completed the 10-weeks intervention (IG). Mean age in the control group (CG) was 74.5 (3.6 SD) vs 79 (3 SD) in the IG, and 78,9% were male in the IG vs 71,4% in the CG. No major adverse events or health-related issues attributable to the testing or training sessions were noted. Significant between-group differences were obtained on visits to the emergency department during the year post-intervention (4 vs 1; p:0.034). No differences were found in mortality rate and readmissions, where an increasing trend was observed in the CG compared with the IG in the latter (2 vs 0; p 0.092). Fried scale was the unique indicator that seemed to be able to detect changes in frailty status after the intervention. Conclusions: A multicomponent exercise training programme seems to reduce the number of visits to the emergency department at one-year post-intervention in older adults with NSCLC during adjuvant therapy or palliative treatment, and is able to modify the frailty status when measured with the Fried scale.

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P121: A quality improvement project to improve medical imaging ordering workflow in the emergency department

CJEM ◽

10.1017/cem.2020.327 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S108-S109

Author(s):

J. Choi ◽

R. Bhayana ◽

D. Wang ◽

E. Bartlett ◽

R. Menezes

Keyword(s):

Emergency Department ◽

Turnaround Time ◽

Radiology Resident ◽

Statistical Process ◽

Improvement Project ◽

Electronic Survey ◽

Ct Utilization ◽

Workflow Efficiency ◽

Ed Visits ◽

After Hours

Background: Many computerized tomography (CT) scans ordered after-hours from the emergency department (ED) at our institution required a discussion between the emergency physician (EP) and radiology resident (RR), leading to workflow inefficiency. Aim Statement: The aim was to improve workflow efficiency and provider satisfaction, and reduce CT turnaround time, without significantly affecting CT utilization within six months. Measures & Design: We created a new workflow by creating an electronic list of ED CT requests that RRs monitor. RRs protocolled all requests and only called the ED physician for more details when required. The intervention was implemented in a stepwise fashion via plan-do-study-act cycles. An electronic survey measured qualitative outcomes, and quantitative outcomes were analyzed via statistical process control (SPC) charts and other statistical methods. Evaluation/Results: Survey response was high (76% EP, 79% RR). Most EPs and RRs felt more efficient (96.3%, 73.3%), RRs felt fewer disruptions (83.3%), and most EPs felt that scans were done faster (84.1%). We analyzed CT turnaround times and utilization using SPC charts and segmented regression analyses. Turnaround time trended to improvement (33 mins vs 29 mins on weekdays [WD], 37 mins vs 33 on weekends [WE]), but was not statistically significant. There was background rising CT utilization over time (+0.7 and + 1.9 CT/100 ED visits/year on WD and WE, respectively, p < 0.0005), but the intervention itself did not cause a significant change. The total number of pages to RR (a measure of workflow disruption) decreased significantly on the WDs (23 vs 19 pages, p = 0.0011), but not on WE (79 vs 75 pages, p = 0.1663). However when adjusting for number of scans ordered, there was a decrease in paging rates (0.73 vs 0.54 pages per scan ordered on WD [p < 0.00005], 3.24 vs 2.63 pages per scan ordered on WE [p = 0.0012]). Discussion/Impact: Our intervention led to improved work satisfaction and perceived efficiency experienced by both EPs and RRs. It did not statistically significantly affect imaging turnaround times or utilization rates. Our project shows that calling for preapproval of imaging studies does not seem to provide any benefit in our setting.

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