title: Reduction in the number and associated costs of unindicated dual-phase head CT examinations after a quality improvement initiative.
abstract: OBJECTIVE
  During this study, we instituted a phased quality improvement initiative designed to educate referring clinicians and departmental radiologists about the recommendations of the American College of Radiology (ACR) Appropriateness Criteria for dual-phase (without and with contrast material) head CT examinations. The primary aims of the study were to evaluate whether the quality improvement initiative was associated with an improvement in ACR Appropriateness Criteria appropriateness ratings and a reduction in the number of unindicated dual-phase head CT examinations performed. A secondary aim was to assess the impact of the quality improvement initiative on health care costs.
  
  
  METHODS
  This study included-with the exception of the examinations performed during a 3-month training period-all single- and dual-phase head CT examinations performed of adult patients at a tertiary care medical center from January 2009 through October 2011. Both inpatients and outpatient examinations were included. There were no exclusion criteria.
  
  
  RESULTS
  Implementation of the initiative enhanced patient safety and reduced health care costs by achieving a significant reduction (p = 0.006) in the number of unindicated dual-phase head CT examinations performed from a median number of 40 per month to 17 per month.
  
  
  CONCLUSIONS
  Although there are potential benefits for dual-phase head CT examinations, the medical and economic risks should be measured against these potential benefits. Incorporating the ACR Appropriateness Criteria applies evidence-based medicine to this algorithm. In this outcomes-driven study, the number of unindicated dual-phase head CT examinations was reduced and imaging efficacy improved primarily through physician education and monitoring.
authors.affiliation: 1 Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, 1161 21st Ave S, R1315 MCN, Nashville, TN 37232-2675.
authors.forename: Megan K
authors.initials: MK
authors.lastname: Strother
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Robert
authors.forename: Jared G
authors.initials: JG
authors.lastname: Cobb
authors.forename: Sumit
authors.initials: S
authors.lastname: Pruthi
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
mesh_terms: D003287:Contrast Media / Q000191:economics; D017046:Cost Savings; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D058996:Quality Improvement; D011829:Radiation Dosage; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
chemical_list: D003287:Contrast Media