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Reducing Unnecessary X-Rays for Nasal Fractures: A Quality Improvement Project
Jess Rhee1, Danielle Kelton2, Sheena Belisle3
1Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada.
Summary
Nasal bone X-rays for nasal fractures were significantly reduced by 73% using a clinical decision support tool and education. This quality improvement initiative lowered costs and environmental impact without increasing CT scans.
Area of Science:
- Radiology
- Quality Improvement
- Healthcare Management
Background:
- Choosing Wisely Canada advises against nasal bone X-rays for nasal fracture evaluation.
- Nasal bone X-rays are often overutilized for diagnosing nasal fractures.
- Reducing unnecessary imaging aligns with evidence-based practice and resource stewardship.
Purpose of the Study:
- To decrease the number of nasal bone X-rays ordered by 50% within one year.
- To assess the impact of a quality improvement initiative on imaging utilization.
- To evaluate cost savings and environmental benefits of reduced X-ray use.
Main Methods:
- Utilized the Institute for Healthcare Improvement Model for Improvement.
- Implemented a pre- and post-intervention study incorporating a clinical decision support tool and provider education.
- Monitored monthly X-ray orders, assessed financial costs, and extrapolated environmental impact (CO2e).
Main Results:
- Achieved a 73% reduction in nasal bone X-rays ordered (197 to 58).
- Demonstrated a statistically significant average monthly reduction of 53% (4.9 to 2.3 X-rays/month).
- Reported cost savings of $5534.98 and an environmental footprint reduction of 111.2 kg CO2e, with no increase in CT scans.
Conclusions:
- A clinical decision support tool and targeted education effectively reduced unnecessary nasal bone X-rays.
- This quality improvement project successfully decreased patient investigations, healthcare costs, and environmental impact.
- The initiative supports Choosing Wisely Canada recommendations and promotes judicious use of diagnostic imaging.
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