Quarterly Reporting of Computed Tomography Ordering History Reduces the Use of Imaging in an Emergency Department

Ehrlichman, R.S.; Dezman, Zachary D.W.; Klein, Joel S.; Jeudy, Jean; Lemkin, Daniel L.

doi:10.1016/j.jemermed.2016.11.014

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…Among studies targeting several imaging modalities or diagnoses, 74–79% of the studies showed a reduction in use of low-value imaging. In contrast, studies targeting one specific modality only showed that targeting X-ray [ 37 , 47 , 48 , 63 , 64 , 83 , 86 , 90 , 92 , 98 , 104 , 112 , 119 , 124 , 130 ], CT [ 41 , 46 , 49 , 53 , 54 , 58 , 60 , 62 , 67 , 69 , 70 , 77 , 79 , 82 , 87 , 88 , 94 – 96 , 101 , 102 , 106 , 108 , 121 – 123 , 125 – 127 , 129 ] or MRI [ 45 , 68 , 75 , 105 , 118 ] led to a 87, 86, and 83% reduction in low-value imaging, respectively. Few studies included other imaging modalities.…”

Section: Resultsmentioning

confidence: 99%

“…Multi-component interventions were found to be more effective when education was one of the components. Following implementation of a single component intervention, 74% of included studies reported decreases in low-value imaging [ 37 – 39 , 45 , 46 , 49 , 50 , 52 , 54 , 55 , 57 , 58 , 60 – 62 , 64 – 71 , 74 – 77 , 80 , 82 , 84 , 85 , 88 – 93 , 95 – 100 , 102 , 103 , 106 – 110 , 113 , 114 , 117 , 119 , 121 , 124 , 125 , 127 , 129 – 131 ]. Data analyses based on the USA studies demonstrated similar results as 96% of multi-component and 68% of single-component interventions showed reduction in the use of low-value imaging.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

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Background It is estimated that 20–50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. Methods An electronic database search was completed in Medline – Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. Results The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. Conclusions Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Kjelle

Andersen

Soril

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Education of emergency and triage clinicians can improve confidence in physical examinations rather than costly radiologic examinations and avoid unnecessary evaluation. Existing literature has demonstrated that quarterly feedback and education on clinical practice guidelines can lead to a reduction in unnecessary imaging and cost to the patient and health care system, particularly in head and neck trauma 54–56 . Interdisciplinary education represents a potential strategy for improving health care outcomes for patients with NBF.…”

Section: Discussionmentioning

confidence: 99%

“…Existing literature has demonstrated that quarterly feedback and education on clinical practice guidelines can lead to a reduction in unnecessary imaging and cost to the patient and health care system, particularly in head and neck trauma. [54][55][56] Interdisciplinary education represents a potential strategy for improving health care outcomes for patients with NBF. Gerontologists and clinicians in adult and family medicine can be educated regarding appropriate counseling for NBFs in lieu of deference to subspecialty referral for fractures managed conservatively.…”

Section: Discussionmentioning

confidence: 99%

Modern Trends in Nasal Bone Fractures and the Effect of Social Distancing

Hoerter,

Huynh,

Doshi

et al. 2024

Journal of Craniofacial Surgery

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Objectives: To assess differences in demographics, incidence, and cause of nasal bone fractures (NBFs) between pre–coronavirus disease 2019 (COVID-19) and COVID-19 eras. Methods: The National Electronic Injury Surveillance System was queried for adult NBF. Two sample t tests and Wald χ2 tests were used to identify changes across the 2012 to 2019 period and 2020 to 2021 period (age, sex, race, location, disposition, and product). Results: There was a total of 523,259 (95% CI: 445,082–601,436) emergency department (ED)–treated adult NBFs in the United States. There was a greater incidence of NBF during COVID-19 (61,621 annual cases; 95% CI: 61,572–61,669) compared with pre–COVID-19 (50,773 annual cases; 95% CI: 50,195–51,351; P < 0.01). Fewer patients with NBF were discharged after ED evaluation during COVID-19 (79.46%; 95% CI: 74.45%–83.70%) compared with before (84.41%; 95% CI: 82.36%–86.28%; P = 0.049, t test). During COVID-19, there was a decrease in sport-associated NBFs, such as basketball [2.36% (95% CI: 1.71%–3.27%) versus 5.21% (95% CI: 4.20%–6.45%), P < 0.01] and baseball [1.18% (95% CI: 0.82%–1.69%) versus 2.22% (95% CI: 1.80%–2.74%), P<0.01], but an increase in fall (66.34% versus 75.02%), alcohol (7.04% versus 12.89%), and drug-associated (0.47% versus 5.70%) NBFs (all P < 0.001). Conclusion: A greater incidence of NBFs has been observed since the start of the COVID-19 pandemic without significant changes in sex or race. Nasal bone fractures during COVID-19 were less likely to be related to sports or discharged from the ED and more likely to be associated with drugs and alcohol. Changes in sociobehavioral patterns during these unprecedented times may account for post–COVID-19 NBF etiologic drift. Level of Evidence: Level II—retrospective cohort study.

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Decision fatigue in the Emergency Department: How does emergency physician decision making change over an eight-hour shift?

Zheng

Kwok

Taljaard

et al. 2020

The American Journal of Emergency Medicine

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Quarterly Reporting of Computed Tomography Ordering History Reduces the Use of Imaging in an Emergency Department

Cited by 3 publications

References 21 publications

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

Modern Trends in Nasal Bone Fractures and the Effect of Social Distancing

Decision fatigue in the Emergency Department: How does emergency physician decision making change over an eight-hour shift?

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