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Appropriate CT cervical spine utilisation in the emergency department
Mark Baker1, Cassie Jaeger2, Carol Hafley3
1Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
BMJ Open Quality
|October 8, 2020
Summary
Implementing a clinical decision tool significantly reduced medically inappropriate CT C-spine scans in the emergency department. This improves care quality and reduces unnecessary radiation exposure.
Area of Science:
- Emergency Medicine
- Health Services Research
- Radiology
Background:
- Over 40,000 CT scans are performed annually in the emergency department, exceeding 80% capacity.
- Improving the medical appropriateness of CT scans can reduce scan volume, time, costs, and radiation exposure.
Purpose of the Study:
- To assess the impact of a National Emergency X-Radiography Utilisation Study (NEXUS)-based clinical decision tool on the appropriateness of CT C-spine scans in the emergency department.
Main Methods:
- Lean Six Sigma methodology was employed to optimize the CT scan ordering process.
- A NEXUS-based PowerForm was integrated into the electronic health record, with provider education on established criteria.
Main Results:
- Potentially medically inappropriate CT C-spine scans decreased from 45% to 22% (p=0.002).
- The disparity in inappropriate order rates between midlevel providers and physicians was eliminated post-intervention (19% vs 22%, p=0.850).
- Overall CT C-spine scan orders decreased from 69.3 to 62.6 per week (p=0.019).
Conclusions:
- Validated clinical decision tools integrated into electronic health records can enhance the quality of emergency care.
- This approach provides a model for improving other imaging studies through validated decision support tools.
