Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, USA.
Department of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY, 10461, USA.
BMC Emerg Med. 2022 Apr 29;22(1):69. doi: 10.1186/s12873-022-00611-x.
Low back pain is a common emergency department (ED) complaint that does not always necessitate imaging. Unnecessary imaging drives medical overuse with potential to harm patients. Quality improvement (QI) interventions have shown to be an effective solution. The purpose of this QI intervention was to increase the percentage of appropriately ordered radiographs for low back pain while reducing the absolute number.
A multi-component intervention led by a clinician champion including staff education, patient education, electronic medical record modification, audit and peer-feedback, and clinical decision support tools was implemented at an urban public hospital Emergency Department. In addition to the total number ordered, Choosing Wisely and American College of Radiology recommendations were used to assess appropriateness of all ED thoracic and lumbar conventional radiographs by chart review over eight months.
The percent of appropriately ordered radiographs increased from 5.8 to 53.9% and the monthly number of radiographs ordered decreased from 86 to 47 over the eight-month initiative. There were no compensatory increases in thoracic or lumbar computed tomography (CT) scans during this time frame.
A multi-component QI intervention led by a clinician champion is an effective way to reduce the overutilization of thoracic and lumbar radiographs in an urban public hospital emergency department.
下背痛是常见的急诊室（ED）就诊原因，但并非总是需要影像学检查。不必要的影像学检查会导致过度医疗，可能对患者造成伤害。质量改进（QI）干预措施已被证明是一种有效的解决方案。本次 QI 干预的目的是增加下背痛患者中适当开具 X 光片的比例，同时减少绝对数量。
在一家城市公立医院的急诊室，由临床医生主导实施了多方面的干预措施，包括员工教育、患者教育、电子病历修改、审核和同行反馈，以及临床决策支持工具。除了总数量外，还通过为期八个月的图表审查，根据选择适宜性（Choosing Wisely）和美国放射学院（ACR）的建议，评估所有 ED 胸腰椎常规 X 光片的适宜性。
适当开具 X 光片的比例从 5.8%增加到 53.9%，在八个月的时间里，每月开具的 X 光片数量从 86 张减少到 47 张。在此期间，胸腰椎计算机断层扫描（CT）扫描没有代偿性增加。
由临床医生主导的多方面 QI 干预措施是减少城市公立医院急诊室胸腰椎 X 光片过度使用的有效方法。
