Ehrlichman Richard, Dezman Zachary, Klein Joel, Jeudy Jean, Lemkin Daniel
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Baltimore-Washington Hospital Center, University of Maryland, Baltimore, Maryland.
J Emerg Med. 2017 May;52(5):684-689. doi: 10.1016/j.jemermed.2016.11.014. Epub 2016 Dec 10.
Computed tomography (CT) is a useful and necessary part of many emergency department (ED) assessments. However, the costs of imaging and the health risks associated with radiation exposure have sparked national efforts to reduce CT ordering in EDs.
We analyzed CT ordering habits prior to and following implementation of a feedback tool at a community hospital.
In this intervention study, we identified the CT-ordering habits of physicians and mid-level care providers (physician assistants and nurse practitioners) at baseline and after implementation of a system that sent quarterly feedback reports comparing their ordering habits with those of their peers. Variability in ordering and subgroup analyses by body region were included in these reports.
We examined the records of 104,454 patients seen between October 1, 2013 and December 31, 2014. There were 5552 or 21.0% of patients seen during the baseline period that underwent CT imaging. We observed an absolute reduction in imaging of 2.3% (95% confidence interval 1.7-2.8%) after implementation, avoiding approximately $400,000 in costs, 22 days of scanning time, and radiation exposure equivalent to 33,000 chest films annually. These changes occurred across physicians and mid-level providers, regardless of the number years of practice or board certification.
Implementation of a feedback mechanism reduced CT use by emergency medicine practitioners, with concomitant reductions in cost and radiation exposure. The change was similar across levels of medical care. Future studies will examine the effect of the feedback reporting system at other institutions in our hospital network.
计算机断层扫描（CT）是许多急诊科评估中有用且必要的部分。然而，成像成本以及与辐射暴露相关的健康风险引发了全国范围内减少急诊科CT检查订单的努力。
我们分析了一家社区医院实施反馈工具前后的CT检查订单习惯。
在这项干预性研究中，我们确定了医生和中级医疗服务提供者（医师助理和执业护士）在基线时以及实施一个每季度发送反馈报告以比较他们与同行的检查订单习惯的系统后的CT检查订单习惯。这些报告包括检查订单的变异性以及按身体部位进行的亚组分析。
我们检查了2013年10月1日至2014年12月31日期间就诊的104454名患者的记录。在基线期就诊的患者中有5552名（占21.0%）接受了CT成像检查。实施后，我们观察到成像检查绝对减少了2.3%（95%置信区间为1.7 - 2.8%），避免了约40万美元的成本、22天的扫描时间以及相当于每年33000张胸部X光片的辐射暴露。这些变化在医生和中级医疗服务提供者中均有发生，与执业年限或专业委员会认证无关。
反馈机制的实施减少了急诊医学从业者对CT的使用，同时降低了成本和辐射暴露。在不同医疗水平中变化相似。未来的研究将考察反馈报告系统在我们医院网络中其他机构的效果。
