title: Quarterly Reporting of Computed Tomography Ordering History Reduces the Use of Imaging in an Emergency Department.
abstract: BACKGROUND
  Computed tomography (CT) is a useful and necessary part of many emergency department (ED) assessments. However, the costs of imaging and the health risks associated with radiation exposure have sparked national efforts to reduce CT ordering in EDs.
  
  
  OBJECTIVE
  We analyzed CT ordering habits prior to and following implementation of a feedback tool at a community hospital.
  
  
  METHODS
  In this intervention study, we identified the CT-ordering habits of physicians and mid-level care providers (physician assistants and nurse practitioners) at baseline and after implementation of a system that sent quarterly feedback reports comparing their ordering habits with those of their peers. Variability in ordering and subgroup analyses by body region were included in these reports.
  
  
  RESULTS
  We examined the records of 104,454 patients seen between October 1, 2013 and December 31, 2014. There were 5552 or 21.0% of patients seen during the baseline period that underwent CT imaging. We observed an absolute reduction in imaging of 2.3% (95% confidence interval 1.7-2.8%) after implementation, avoiding approximately $400,000 in costs, 22 days of scanning time, and radiation exposure equivalent to 33,000 chest films annually. These changes occurred across physicians and mid-level providers, regardless of the number years of practice or board certification.
  
  
  CONCLUSIONS
  Implementation of a feedback mechanism reduced CT use by emergency medicine practitioners, with concomitant reductions in cost and radiation exposure. The change was similar across levels of medical care. Future studies will examine the effect of the feedback reporting system at other institutions in our hospital network.
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Richard
authors.initials: R
authors.lastname: Ehrlichman
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Dezman
authors.affiliation: Baltimore-Washington Hospital Center, University of Maryland, Baltimore, Maryland.
authors.forename: Joel
authors.initials: J
authors.lastname: Klein
authors.affiliation: Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Jean
authors.initials: J
authors.lastname: Jeudy
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lemkin
mesh_terms: D002983:Clinical Competence / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000379:methods* / Q000706:statistics & numerical data
keywords: advanced imaging; department operations; radiation