Tay Yi Xiang, Chan Ling Ling, Than Shin Ru, Lim Gek Hsiang, Tan Mark Bangwei, Mak May San, Hou Wenlu, Wee Jeremy Choon Peng, Ng Yeong Huei, Chen Robert Chun
Radiography Department, Division of Allied Health, Singapore General Hospital, Outram Rd., Singapore 169608, Singapore.
Department of Diagnostic Radiology, Division of Radiological Sciences, Singapore General Hospital, Outram Rd., Singapore 169608, Singapore.
Int J Qual Health Care. 2023 Apr 29;35(2). doi: 10.1093/intqhc/mzad021.
The demand for diagnostic imaging continues to rise. Against the backdrop of rising health care costs and finite resources, this has prompted a paradigm shift toward value-driven patient care. Inappropriate imaging is a barrier toward achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral Emergency Department (ED) and assess whether physicians' specialization and years of experience influence appropriateness. A total of 1030 lumbar spine radiographs performed in the ED of an academic medical center over a consecutive 3-month period were reviewed retrospectively. Referral indications were reviewed for adherence to 2021 American College of Radiology appropriateness guidelines for lower back pain, and referral patterns were evaluated among physician groups based on specialists' training and years in practice. 63.8% of lumbar spine radiographs were appropriate, with trauma being the most common indication. 36.2% of orders were inappropriate, with lower back pain of <6 weeks duration being the most common indication. Significant differences in inappropriate orders were found (P < .001) across physician groups: qualified Emergency Medicine specialists (20.9% inappropriate orders), specialists in training (27.8%), and non-specialists with ≥3 (60.0%) and <3 (36.9%) years in practice, respectively. Approximately one-third of lumbar spine radiographs performed in the ED were inappropriately ordered by American College of Radiology guidelines; specialists training and years in practice affected referral patterns. Integrating evidence-based appropriateness guidelines into the physician order workflow and targeting older non-specialists may promote more judicious imaging and reduce health care costs.
对诊断成像的需求持续上升。在医疗保健成本不断上涨和资源有限的背景下，这促使了向价值驱动型患者护理的范式转变。不恰当的成像检查是实现这一目标的障碍，它与现行的循证指南背道而驰，并导致医疗保健成本上升。我们的目的是评估三级转诊急诊科（ED）中腰椎X线检查的恰当性，并评估医生的专业领域和工作年限是否会影响恰当性。回顾性分析了一所学术医疗中心急诊科在连续3个月内进行的总共1030例腰椎X线片检查。根据2021年美国放射学会关于下背痛的恰当性指南，审查转诊指征的依从性，并根据专家培训和执业年限评估医生群体之间的转诊模式。63.8%的腰椎X线片检查是恰当的，其中创伤是最常见的指征。36.2%的检查申请不恰当，持续时间<6周的下背痛是最常见的指征。不同医生群体的不恰当检查申请存在显著差异（P<0.001）：合格的急诊医学专家（20.9%的不恰当检查申请）、培训中的专家（27.8%）、执业≥3年（60.0%）和<3年（36.9%）的非专家。根据美国放射学会指南，急诊科约三分之一的腰椎X线片检查申请不恰当；专家培训和执业年限影响转诊模式。将循证恰当性指南纳入医生检查申请流程，并针对年长的非专家，可能会促进更明智的成像检查，并降低医疗保健成本。
