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Penn decision support tool cuts CT use in the ED

Nick Bartz, Imaging Performance Partnership

A new decision support tool piloted at the University of Pennsylvania has cut the number of abdominal CT scans ordered by ED physicians by 10%. In a paper presented at the recent Society for Academic Emergency Medicine (SAEM) meeting in Chicago, researchers from the University’s Perelman School of Medicine described how their tool, “embedded” within patient EMRs, is cutting potentially unnecessary scans, and helping to reduce excessive radiation exposure. 

Over 10 million patients seek care for abdominal pain in emergency rooms across the United States every year. The pain can be caused by a multitude of different ailments. Some, like ectopic pregnancy or appendicitis, can prove life threatening within hours, but in many cases, less severe conditions, like constipation, can be fixed with simple over the counter remedies. In many cases, ED physicians, pressed by time and workflow constraints, will order unnecessary Abdominal CT scans to diagnose less serious conditions, often exposing patients to unnecessarily high levels of radiation.

At Penn, a decision support tool is triggered whenever a physician attempts to order an abdominal CT scan for a patient. Before the exam is confirmed, the tool walks physicians through a series of questions that help assess the necessity of the scan. Furthermore, if the scan is ordered by a medical resident, the tool requires that it be approved by an attending physician before the order is finalized.

The tool was used a total of 11,176 times over two Penn Medicine emergency departments between July 2011 and March 2012. Prior to its implementation, 32.3% of adult patients admitted for abdominal pain received CT scans. After the tool was implemented this figure dropped to 28%. Importantly, there was no concurrent increase in the number of patients admitted to the hospital for observation after implementation of the tool, which would be expected if the reduction in CT scans had increased diagnostic uncertainty.

In the next phase of the project, researchers are adding further information to the tool, including how many prior abdominal imaging tests patients have had at Penn and their cumulative radiation exposure. Researchers hope that this additional data will continue to help cut unnecessary tests.