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Phase Contrast and Differential Interference Contrast DIC Microscopy
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Timeout for Contrast: Using Physician Behavior Modification to Reduce Contrast in the Catheterization Laboratory.

Robby Singh1, Marcel Zughaib1

  • 1Providence Hospital/Michigan State University, Southfield, MI, USA.

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|February 16, 2019
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Summary

Implementing a checklist intervention significantly reduced contrast media use in cardiac catheterization, lowering the risk of contrast-induced nephropathy (CIN). This physician behavioral modification proved effective and sustainable over three years.

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Area of Science:

  • Cardiology
  • Nephrology
  • Health Informatics

Background:

  • Rising contrast media use increases healthcare burden due to complications like contrast-induced nephropathy (CIN).
  • CIN is a frequent complication following cardiac catheterization procedures.

Purpose of the Study:

  • To assess the effectiveness of physician behavioral modification in reducing contrast media volume during procedures.
  • To evaluate the impact of a preprocedure checklist intervention on contrast usage.

Main Methods:

  • Retrospective analysis of 12,118 cardiac catheterization cases from January 2013 to August 2016.
  • Introduction of a maximum allowed contrast volume on the preprocedure checklist in September-October 2013.
  • Comparison of contrast volumes before and after the intervention, analyzing trends over three years.

Main Results:

  • Mean contrast used decreased from 118 ml pre-intervention to 105 ml (year 1), 106 ml (year 2), and 99 ml (year 3) post-intervention.
  • A significant and sustained reduction in radiocontrast use was observed across all operators and procedures.
  • The intervention demonstrated a clear impact on physician behavior regarding contrast administration.

Conclusions:

  • A simple physician behavioral modification, via a revised timeout procedure, significantly reduced contrast media use.
  • This reduction in contrast exposure lowers patient risk for dose-dependent contrast-induced nephropathy (CIN) and related complications.
  • The observed decrease in contrast usage was sustained over a three-year period, indicating long-term effectiveness.