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A collaborative tale of quality and quantity enabling emergency physicians to order ct scans without prior consultation with medical imaging did not increase ct utilization st. michael's
A collaborative tale of quality and quantity enabling emergency physicians to order ct scans without prior consultation with medical imaging did not increase ct utilization st. michael's
A collaborative tale of quality and quantity enabling emergency physicians to order ct scans without prior consultation with medical imaging did not increase ct utilization st. michael's
A collaborative tale of quality and quantity enabling emergency physicians to order ct scans without prior consultation with medical imaging did not increase ct utilization st. michael's
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A collaborative tale of quality and quantity enabling emergency physicians to order ct scans without prior consultation with medical imaging did not increase ct utilization st. michael's

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  • 1. A collaborative tale of Quality AND Quantity: Enabling Emergency Physicians to order CT scans without prior consultation with Medical Imaging did not increase CT utilization D MacKinnon1, 2 M McGowan1 DM King3 T Dowdell3, 4 G Bandiera1, 5 Emergency Medicine, St. Michael’s Hospital Department of Family and Community Medicine, University of Toronto 3 Medical Imaging, St. Michael’s Hospital 4 Department of Medical Imaging, University of Toronto 5 Department of Medicine, University of Toronto 1 2
  • 2. Enabling EPs to order CTs without prior consultation with MI Context • CT is a diagnostic tool ordered at the discretion of the Emergency Physician (EP) to aid in the diagnosis, treatment and disposition of patients; however, there is growing concern about the increasing patient radiation exposure with its more frequent use • Perceptions exist that CT requests by EPs should be “approved” in advance by Medical Imaging (MI) to manage utilization, organize workflow and monitor radiation exposure to patients St. Michael’s Hospital, Toronto, ON • Urban, academic, inner city, level-1 trauma centre (ED volume 72,000 in 2012) Problem and Issue • Mandating discussion between the EP and MI prior to “approving” contrast CT orders involved challenges in contacting the appropriate person in MI, leading to delays in timeto-imaging, time-to-diagnosis and increasing patients’ ED length of stay • Collaboratively, the ED and MI made multiple attempts to overcome these communication and workflow challenges • MI voiced concern if a process similar to the non-contrast CT (no consultation needed) was implemented the impact on utilization and workflow would need to be closely monitored
  • 3. Enabling EPs to order CTs without prior consultation with MI Measurement • A collaborative change in practice to streamline the process of ordering CT scans M-F 8-5 enabled EPs to order contrast CTs without prior consultation with MI M-F (nonholidays) starting October 25, 2010 • Bi-directional communication was available and encouraged for EP consultation with MI AND MI consultation with EP to discuss CT requests if considered necessary • A retrospective review of PACS for contrast CTs ordered by EPs and patient volumes was conducted pre- and post- implementation of change of practice • The change on absolute number and rate of CT ordering by the EPs 1-year pre- and post- process change was measured Figure 1. Absolute Number CTs by Emergency Physicians Table 1. Rate of CTs ordered by Emergency Physicians Metric By Year Pre- Post- Overall Change 62,881 67,282 6.9% Total CTs by EPs 6815 6618 -2.9% CTs ordered per Pt 0.11 0.10 -1.0% Total Pt Visits
  • 4. Enabling EPs to order CTs without prior consultation with MI Contribution to Patient Safety & Quality Improvement • Enabling Emergency Physicians to order contrast CT without prior discussion with Medical Imaging did not increase CT utilization and thus did not increase patient radiation exposure Collaborative Emergency-Medical Imaging • Ongoing monitoring of absolute number and rate of CT ordering by EPs is an important quality metric Innovative Patient Flow Initiative • This process change may be considered by other Emergency Departments to address patient flow and length of stay metrics and targets Lessons Learned • Collaborative efforts between hospital departments, such as this, can lead to positive changes in patient care and flow processes at minimal to no cost

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