Burton Kirsteen R, Lawlor Raymond L, Dhanoa Deljit
Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor, Toronto, ON M5T1W7, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T3M6, Canada.
Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor, Toronto, ON M5T1W7, Canada.
Acad Radiol. 2016 May;23(5):588-91. doi: 10.1016/j.acra.2015.11.016. Epub 2016 Mar 2.
We evaluated the effects of a streamlined emergency department (ED) policy for CT ordering, pre- and postimplementation, on the completed imaging study rates of all after-hours computed tomography (CT) studies. The study hypothesis was that a streamlined CT ordering process would increase the utilization rates of ED CT.
A prospective cohort study was used to estimate the effect of enhancing a preauthorization policy for after-hours CT studies requested through the ED, performed between January 1 and June 30, 2013, and the postimplementation period, performed between January 1 and June 30, 2014. Inclusion criteria were all CT chest, CT abdomen/pelvis, musculoskeletal, neurological, and neuroangiographic examinations performed by ED physicians on adult patients. Pre- and postintervention examination imaging study rates were compared.
The period following implementation of the preauthorization policy was associated with a statistically significant increase in utilization for most subtypes of CT examinations (CT chest, CT abdomen/pelvis, and musculoskeletal CT studies), with the exception of neurological examinations, which showed a significant decrease.
This study demonstrates a trend toward increased utilization of CT resources after implementation of an ED preauthorization policy with most study types showing significantly increased utilization. In the case of neurological examinations, a potential "substitution effect" was observed, whereby the rates of neuroangiographic studies showed a marked increase, offsetting the decrease in general neurological examinations performed. Departments considering implementation of preauthorization policies should weigh carefully the benefits of ED workflow efficiencies against the potential harms of increased CT use.
我们评估了急诊室（ED）简化CT检查医嘱政策在实施前后对所有非工作时间计算机断层扫描（CT）检查的完整成像研究率的影响。研究假设是简化的CT检查医嘱流程将提高急诊室CT的利用率。
采用前瞻性队列研究来评估加强对通过急诊室申请的非工作时间CT检查的预授权政策的效果，该研究在2013年1月1日至6月30日期间进行，并与2014年1月1日至6月30日的实施后阶段进行对比。纳入标准为急诊室医生对成年患者进行的所有胸部CT、腹部/盆腔CT、肌肉骨骼CT、神经CT和神经血管造影检查。比较干预前后检查成像研究率。
预授权政策实施后的时期与大多数CT检查亚型（胸部CT、腹部/盆腔CT和肌肉骨骼CT研究）的利用率在统计学上显著增加相关，但神经检查除外，其显示显著下降。
本研究表明，实施急诊室预授权政策后，CT资源利用率有增加的趋势，大多数研究类型的利用率显著提高。在神经检查方面，观察到一种潜在的“替代效应”，即神经血管造影研究率显著增加，抵消了一般神经检查的减少。考虑实施预授权政策的科室应仔细权衡急诊室工作流程效率的益处与CT使用增加的潜在危害。
