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Effect of a preauthorization policy on the utilization rate of after-hours emergency department neuroradiology computed tomography

Published online by Cambridge University Press:  04 March 2015

Deljit Dhanoa ,
Kirsteen Rennie Burton ,
Lyne Noël de Tilly  and
Ravi J. Menezes
Deljit Dhanoa*
Affiliation:
Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON
Kirsteen Rennie Burton
Affiliation:
Department of Medical Imaging, University of Toronto, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
Lyne Noël de Tilly
Affiliation:
Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON
Ravi J. Menezes
Affiliation:
Department of Medical Imaging, University Health Network, Toronto, ON
*
13 Seton Park Road, Toronto, ON M3C 3Z7; dhanoad@yahoo.com

Abstract

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Objective:

To evaluate the impact of an emergency department (ED) automatic preauthorization policy on after-hours utilization of neuroradiology computed tomography (CT).

Methods:

All CT studies of the head with contrast facial bones, orbits, spine, and neck requested through the ED and performed between January 1, 2004, and December 31, 2010, were reviewed. The preauthorization policy was instituted on February 25, 2008. A control group of noncontrast CT head studies was used for comparison. Pre- and postpolicy implementation utilization rates were compared between the control group of noncontrast CT head studies and the study group neuroradiology CT studies.

Results:

During the study period, 408,501 ED patient visits occurred and 20,703 neuroradiology CT studies were carried out. The pre- and postimplementation groups of noncontrast CT head scans totalled 7,474 and 6,094, respectively, whereas the pre- and postimplementation groups of all other neuroradiology CT studies totalled 3,833 and 3,302, respectively. The CT utilization between the two groups did not differ significantly: the noncontrast head group pre- and postpolicy implementation increased by 0.31 to 3.41%, whereas the utilization of all other neuroradiology CT studies increased by 0.22 to 1.84% (p value = 0.061 for a difference between groups).

Conclusion:

Implementation of an automatic preauthorization policy for after-hours neuroradiology CT studies did not result in a statistically significant increase in CT utilization. This suggests that concerns regarding the negative effects of such policiesmay be unfounded, and further research in this area is warranted.

Keywords

computed tomographyemergency medicineneuroradiologyradiologyutilizationutilization rate
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 3 , May 2013 , pp. 161 - 166
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1.Broder, J, Warshauer, DM. Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol 2006;13:25–30, doi:10.1007/s10140-006-0493-9.Google Scholar
2.Broder, JS. CT utilization: the emergency department perspective. Pediatr Radiol 2008;38 Suppl 4:S664-9, doi:10.1007/s00247-008-0892-z.CrossRefGoogle ScholarPubMed
3.Korley, FK, Pham, JC, Kirsch, TD. Use of advanced radiology during visits to US emergency departments for injuryrelated conditions, 1998–2007. JAMA 2010;304:1465–71, doi:10.1001/jama.2010.1408.Google Scholar
4.Bhuiya, FA, Pitts, SR, McCaig, LF. Emergency department visits for chest pain and abdominal pain: United States, 1999–2008. NCHS Data Brief 2010;43:1–8.Google Scholar
5.Lee, J, Kirschner, J, Pawa, S, et al. Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007. Ann Emerg Med 2010;56:591–6, doi:10.1016/j.annemergmed.2010.05.027.Google Scholar
6.Oguz, KK, Yousem, DM, Deluca, T, et al. Effect of emergency department CT on neuroimaging case volume and positive scan rates. Acad Radiol 2002;9:1018–24, doi:10.1016/S1076-6332(03)80477-4.CrossRefGoogle ScholarPubMed
7.Brenner, DJ, Hall, EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med 2007;357:2277–84, doi:10.1056/NEJMra072149.CrossRefGoogle ScholarPubMed
8.Jordan, YJ, Lightfoote, JB, Jordan, JE. Computed tomography imaging in the management of headache in the emergency department: cost efficacy and policy implications. J Natl Med Assoc 2009;101:331–5.Google ScholarPubMed
9.Stiell, IG, Clement, CM, Grimshaw, JM, et al. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. CMAJ 2010;1821:1527–32, doi:10.1503/cmaj.091974.CrossRefGoogle Scholar
10.Heskestad, B, Baardsen, R, Helseth, E, et al. Guideline compliance in management of minimal, mild, and moderate head injury: high frequency of noncompliance among individual physicians despite strong guideline support from clinical leaders. J Trauma 2008;65:1309–13, doi:10.1097/TA.0b013e31815e40cd.Google Scholar
11.Lee, KL, Graham, CA, Lam, JM, et al. Impact on trauma patient management of installing a computed tomography scanner in the emergency department. Injury 2009;40:873–5, doi:10.1016/j.injury.2008.12.001.Google Scholar
12.Wong, DC, Siddle, KJ. After-hours radiology. Australas Radiol 1994;38:326–30, doi:10.1111/j.1440-1673.1994.tb00211.x.CrossRefGoogle ScholarPubMed
13.Ravindran, V, Sennik, D, Hughes, RA. Appropriateness of out-of-hours CT head scans. Emerg Radiol 2007;13:181–5.CrossRefGoogle ScholarPubMed
14.Wong, AC, Kowalenko, T, Roahen-Harrison, S, et al. A survey of emergency physicians’ fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma. Pediatr Emerg Care 2011;27:182–5, doi:10.1097/PEC.0b013e31820d64f7.CrossRefGoogle ScholarPubMed
15.Summerfield, R, Macduff, R, Davis, R, et al. Comparative yield of positive brain computed tomography after implementing the NICE or SIGN head injury guidelines in two equivalent urban populations. Clin Radiol 2011;66:308–14, doi:10.1016/j.crad.2010.06.018.Google Scholar
16.Eagles, D, Stiell, IG, Clement, CM, et al. International survey of emergency physicians’ awareness and use of the Canadian Cervical-Spine Rule and the Canadian Computed Tomography Head Rule. Acad Emerg Med 2008;15:1256–61, doi:10.1111/j.1553-2712.2008.00265.x.Google Scholar
17.Shah, NA, Hoch, M, Willis, A, et al. Correlation among oncall resident study volume, discrepancy rate, and turnaround time. Acad Radiol 2010;17:1190–4, doi:10.1016/j.acra.2010.06.003.Google Scholar