Take a ‘timeout’ in the ED to reduce repeat CT exams | Rare Techy


The findings show that a relatively simple intervention can reduce unnecessary imaging and improve patient care, said lead author Dr. Ferko Berger told the session attendees.

“Having an in-house emergency radiologist who evaluates CTs from being sent to hospitals … significantly reduces the number of repeat CTs and radiation exposure,” he said.

Transferred trauma patients with CT exam results from the sending hospital often get another exam at the receiving hospital, Berger said. But these additional CT exams may not be necessary, and they can have real consequences such as patient care delays, unnecessary radiation and contrast exposure, and increased healthcare costs, he noted.

A study of 416 patients evaluated the effect of an “imaging timeout” intervention involving a meeting between the emergency department trauma team and the radiologist and additional CT for patients transferred to hospitals. Two steps.

In the first (observation) phase, a radiologist discussed with the trauma team, and in the second (intervention) phase, the radiologist and trauma team met for a “timeout” during which they assessed adequacy. Discussed whether to have a second exam of the initial external CT exam. Berger’s group tracked the reasons for doing a second CT exam, the number of exams blocked, and the radiation and contrast dose. In the total study cohort, 318 patients were enrolled in the first phase and 98 patients in the second phase.

The investigators found that the second phase intervention reduced repeat CT examinations by 29% and estimated radiation exposure by 24%.

Effect of ‘timeout’ intervention on repeated CT examination events
measure Phase I (Observation) Phase II (Intervention) Percentage Reduction/Prevention
Number of repeat CT examinations 1.7 per patient 1.2 per patient -29%
Blocked number of CT exams 2.2 per patient -45%
Estimated radiation exposure due to repeated CT examinations 14.1 mSv per patient 10.9 mSv per patient -24%
No CT examinations were performed at the hospital 6% of patients 19% of patients

Inadequate or incomplete images were the most common reasons prompting hospital emergency physicians to order repeat CT examinations for transfer trauma patients; inadequate external reports or reports with discordant findings; and the need to assess injury progression.

Berger acknowledged that the study’s limitations included a lack of data on the reason for the second CT exam at the receiving hospital — for example, to complete the protocol or to assess injury progression.

But the fact is, when radiologists and trauma physicians take the time to check with each other, unnecessary imaging decreases, according to Berger.

“A multidisciplinary timeout discussion can prevent a significant number of CTs from recurring,” he said.

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