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Performance improvement and patient safety program-guided quality improvement initiatives can significantly reduce
Christopher R Connelly1, John D Yonge, Lynn E Eastes
1From the Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery (C.R.C., J.D.Y., L.E.E., P.E.B., P.M.K.B., M.A.S., J.M.W.), Oregon Health & Science University, Portland, Oregon; Division of Pediatric Surgery, Department of Surgery (K.S.A., M.A.J.), Oregon Health & Science University, Portland, Oregon; Doernbecher Children's Hospital, Randall Children's Hospital (M.A.J.), Oregon Health & Science University, Portland, Oregon.
Insights
A performance improvement program significantly reduced computed tomography (CT) scans for pediatric cervical spine (C-spine) injuries. This initiative decreased radiation exposure and cancer risk in children, demonstrating effective patient safety protocols.
Area of Science:
- Pediatric Traumatology
- Radiology and Imaging
- Public Health and Patient Safety
Background:
- Pediatric cervical spine (C-spine) injuries carry high morbidity and mortality.
- Minimizing radiation exposure is crucial, necessitating reduced reliance on computed tomography (CT).
- High rates of CT scans for C-spine clearance in pediatric trauma patients prompted an institutional initiative.
Purpose of the Study:
- To evaluate the impact of a performance improvement and patient safety (PIPS) program on C-spine imaging in pediatric trauma patients.
- To assess changes in CT utilization, radiation exposure, and associated cancer risks following PIPS implementation.
- To determine compliance rates with the PIPS protocol for C-spine clearance.
Main Methods:
- Retrospective review of pediatric trauma patients (0-14 years) comparing pre- and post-PIPS implementation periods.
- Comparison of C-spine CT rates, overall CT rates, other imaging modalities, and radiation exposure.
- Review of patient characteristics, injury severity, and compliance with the PIPS protocol.
Main Results:
- Significant decrease in C-spine CT rates (30% to 13%) and overall CT rates (60% to 45%) post-PIPS.
- Significant increase in C-spine plain x-ray rates (7% to 25%) with no change in MRI utilization.
- Estimated reduction in lifetime attributable risk (LAR) for cancer: 22% (males) and 38% (females) for any cancer; 54% for thyroid cancer. Excellent protocol compliance (82-90%) observed in 2014.
Conclusions:
- A PIPS program effectively reduces ionizing radiation exposure in pediatric trauma patients.
- The protocol led to decreased C-spine CT scans, reduced LAR for thyroid cancer, and overall CT imaging reduction.
- This demonstrates the success of a focused C-spine imaging protocol in improving patient safety and minimizing radiation risks.
Background:
Morbidity and mortality of cervical spine (C-spine) injury in pediatric trauma patients are high, necessitating quick and accurate diagnosis. Best practices emphasize minimizing radiation exposure through decreased reliance on computed tomography (CT), instead using clinical assessment, physical examination, and alternate imaging techniques. We implemented an institutional performance improvement and patient safety (PIPS) program initiative for C-spine clearance in 2010 because of high rates of CT scans among pediatric trauma patients.
Methods:
A retrospective review of pediatric trauma patients, aged 0 years to 14 years, in the pre- and post-PIPS implementation periods was conducted. Rates of C-spine CT, overall CT, other imaging modalities, radiation exposure, patient characteristics, and injury severity were compared, and compliance with PIPS protocol was reviewed.
Results:
Patient characteristics and injury severity were similar before and after PIPS implementation. C-spine CT rates decreased significantly between groups (30% vs. 13%, p < 0.001), whereas C-spine plain x-ray rates increased significantly (7% vs. 25%, p < 0.001). There was no difference in C-spine magnetic resonance imaging between groups (12% vs. 10%, p = 0.11). In 2007, 71% of patients received a CT scan for any reason. However, the overall CT rate decreased significantly between groups (60% vs. 45%, p < 0.001). There was an estimated 22% decrease in lifetime attributable risk (LAR) for any cancer due to ionizing imaging exposure in males and 38% decrease in females between the pre- and post-PIPS groups. There was a 54% decrease in LAR for thyroid cancer in males and females between groups; 2014 compliance with the protocol was excellent (82-90% per quarter).
Conclusions:
Performance improvement and patient safety program-generated protocol can significantly decrease ionizing radiation exposure. We demonstrate that a simple protocol focused on C-spine imaging has high compliance, decreased C-spine CT scans, and decreased LAR for thyroid cancer. A secondary benefit is a reduction in total CT imaging, with an associated decrease in LAR for all cancers.
Level Of Evidence:
Therapeutic study, level IV; diagnostic study, level III.
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