Department of Emergency Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
Department of Operations Improvement, Memorial Health System, Springfield, Illinois, USA
BMJ Open Qual. 2020 Oct;9(4). doi: 10.1136/bmjoq-2019-000844.
Over 40 000 CT scans are performed in our emergency department (ED) annually and utilisation is over 80% capacity. Improving medical appropriateness of CT scans may reduce total number of scans, time, cost and radiation exposure.
Lean Six Sigma methodology was used to improve the process. A National Emergency X-Radiography Utilisation Study (NEXUS)-based PowerForm was implemented in the electronic health record and providers were educated on the criteria.
The rate of potentially medically inappropriate CT C-spine scans decreased from 45% (19/42) to 22% (90/403) (two-proportion test, p=0.002). After the intervention, there was no longer a difference between midlevel providers and physicians in the rate of medically inappropriate orders (19% vs 22%) (two-proportion test, p=0.850) compared with that before the intervention (56% vs 31%) (two-proportion test, p<0.01). Overall rates of CT C-spine scans ordered decreased from 69.3 to 62.6/week (t-test, p=0.019).
A validated clinical decision-making tool implemented into the medical record can improve quality of care. This study lays a foundation for other imaging studies with validated support tools with similar potential improvements.
我们的急诊科每年进行超过 40000 次 CT 扫描，利用率超过 80%。提高 CT 扫描的医学适宜性可以减少扫描的总数、时间、成本和辐射暴露。
采用精益六西格玛方法改进流程。在电子病历中实施了基于国家急诊 X 射线利用研究（NEXUS）的 PowerForm，并对医务人员进行了标准培训。
潜在医学上不适当的 CT C 型脊柱扫描率从 45%（19/42）降至 22%（90/403）（两比例检验，p=0.002）。干预后，中级医生和医生开具不适当医嘱的比例（19%比 22%）与干预前相比没有差异（56%比 31%）（两比例检验，p=0.850）。CT C 型脊柱扫描的总检查率从 69.3 次/周降至 62.6 次/周（t 检验，p=0.019）。
将经过验证的临床决策工具嵌入病历中可以提高医疗质量。这项研究为其他具有类似潜在改进的经过验证支持工具的影像学研究奠定了基础。
