title: Cost containment in the use of low-osmolar contrast agents: effect of guidelines, monitoring, and feedback mechanisms.
abstract: OBJECTIVE
  To describe a program for controlling intravenous use of low-osmolar contrast agents (LOCAs).
  
  
  METHODS
  The department of radiology at the authors' institution adopted a policy of selective use of intravenously administered LOCAs. Clinical indications for LOCA use were specified after consultation with the administration, risk managers, legal department, and ethics committee of the hospital. The guidelines were then publicized throughout the department and hospital, and a contrast agent data form was developed to collect data on all cases. Monitoring mechanisms were instituted.
  
  
  RESULTS
  Over the next 23 months, 11,373 patients received intravenous iodinated contrast agents, of whom 28.1% were deemed to be at high risk and were given LOCAs. Monthly tracking showed no evidence of a trend toward increasing use of LOCAs.
  
  
  CONCLUSIONS
  Clear definition of use guidelines, close monitoring, and feedback can stabilize LOCA use at acceptably low levels.
authors.affiliation: Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
authors.forename: D C
authors.initials: DC
authors.lastname: Levin
authors.forename: G A
authors.initials: GA
authors.lastname: Gardiner
authors.forename: S
authors.initials: S
authors.lastname: Karasick
authors.forename: G S
authors.initials: GS
authors.lastname: Shaber
authors.forename: R J
authors.initials: RJ
authors.lastname: Wechsler
authors.forename: G H
authors.initials: GH
authors.lastname: McArdle
authors.forename: C D
authors.initials: CD
authors.lastname: Lockard
authors.forename: R J
authors.initials: RJ
authors.lastname: Harford
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects / Q000191:economics*; D003363:Cost Control; D005260:Female; D005568:Forms and Records Control; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D015143:Philadelphia; D017410:Practice Guidelines as Topic; D011872:Radiology Department, Hospital / Q000191:economics*; D012307:Risk Factors
chemical_list: D003287:Contrast Media