title: Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department.
abstract: OBJECTIVE
  Clinical decision rules have reduced use of computed tomography (CT) to evaluate minor pediatric head injury in pediatric emergency departments (EDs). CT use remains high in community EDs, where the majority of children seek medical care. We sought to reduce the rate of CT scans used to evaluate pediatric head injury from 29% to 20% in a community ED.
  
  
  METHODS
  We evaluated a quality improvement (QI) project in a community ED aimed at decreasing the use of head CT scans in children by implementing a validated head trauma prediction rule for traumatic brain injury. A multidisciplinary team identified key drivers of CT use and implemented decision aids to improve the use of prediction rules. The team identified and mitigated barriers. An affiliated children's hospital offered Maintenance of Certification credit and QI coaching to participants. We used statistical process control charts to evaluate the effect of the intervention on monthly CT scan rates and performed a Wald test of equivalence to compare preintervention and postintervention CT scan proportions.
  
  
  RESULTS
  The baseline period (February 2013-July 2014) included 695 patients with a CT scan rate of 29.2% (95% confidence interval, 25.8%-32.6%). The postintervention period (August 2014-October 2015) included 651 patients with a CT scan rate of 17.4% (95% confidence interval, 14.5%-20.2%,P< .01). Barriers included targeting providers with variable pediatric experience and parental imaging expectations.
  
  
  CONCLUSIONS
  We demonstrate that a Maintenance of Certification QI project sponsored by a children's hospital can facilitate evidence-based pediatric care and decrease the rate of unnecessary CT use in a community setting.
authors.affiliation: Divisions of General Pediatrics and Hospital Medicine and rebecca.jennings@seattlechildrens.org.|Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington; and.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Jennings
authors.affiliation: Providence St Peter Hospital Emergency Department, Olympia, Washington.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Burtner
authors.affiliation: Providence St Peter Hospital Emergency Department, Olympia, Washington.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Pellicer
authors.affiliation: Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington; and.
authors.forename: Deepthi K
authors.initials: DK
authors.lastname: Nair
authors.affiliation: Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington; and.
authors.forename: Miranda C
authors.initials: MC
authors.lastname: Bradford
authors.affiliation: Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington; and.
authors.forename: Michele
authors.initials: M
authors.lastname: Shaffer
authors.affiliation: Emergency Medicine, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Neil G
authors.initials: NG
authors.lastname: Uspal
authors.affiliation: Divisions of General Pediatrics and Hospital Medicine and.|Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, Washington; and.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Tieder
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D058996:Quality Improvement; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000706:statistics & numerical data