A recent review of data from the University of Michigan Health System revealed what many of us working to make Emergency Departments more efficient already knew: more emergency doctors are ordering more CT scans.
Using data from 1996 through 2007, researchers found nearly 1 in 7 ED patients now get a CT scan. The rate of scans has grown 11 times faster than the rate of actual ED visits.
The study has made the rounds in the media, from Reuters to Science Daily. And it’s a trend MEP has seen in its own emergency departments. What the stories don’t mention, though, is what can be done to bring use of the expensive scans under some kind of reasoned control.
We have undertaken a process to track CT scan use per provider. We count how many abdominal, head and chest CT scans are being ordered by our physicians, PAs, and nurse practitioners per 100 patients seen. But here is the important part: we release the results unblinded to our providers so they can see where they stand relative to their colleagues.
Think of the programs being used by utility companies to reduce energy use. These programs give customers a bill with their own electricity consumption matched up to the average for their neighborhood. Now imagine that you could actually see your neighbors’ names, and they could see yours. That’s what we’re doing with CT scans.
In any group like this there are outliers, either on the high end or the low end. The first goal of sharing information like we’ve chosen to do then is to narrow the spread. Doctors on the high end, the ones ordering several times the number of CT scans as the norm, can’t help but look at the results and wonder if they shouldn’t be adjusting their use of the procedure.
Not that the approach to this problem is entirely in the hands of doctors. The causes of increased CT scan use were well covered – the availability of the devices, the rising standard of care, and concern about medical liability all contribute. Ordering a CT scan certainly increases the certainty of the diagnosis and could keep more patients from being admitted to the hospital (as the study suggested). On the other hand we can’t always do every test to rule out every possible condition.
Among the myriad competing demands, we are striving for a reasoned approach. That begins with showing providers the numbers. Theirs and their colleagues’.