Tuesday 4 July 2017

Herding CATS: ED CT Utilization Pilot Study: Provider Factors




There is a growing world-wide literature concerning the increased use of computerized tomography (CT) scan examinations in the emergency department setting. The reasons for the increased rates seen have been predominantly attributed to the role of CT in providing rapid and accurate diagnostic imaging. [Oh] As Chang et al point out, “CT is a useful diagnostic tool for the differential of many acute conditions, rendering it an ideal and integral diagnostic tool in the ED setting.” [Chang] Other driving forces to CT utilization have been discussed in the literature. “Factors cited for this trend include a need for rapid, accurate diagnosis, a general trend towards less invasive testing, and increasing concern about malpractice litigation and an increasing public awareness of, and often desire for, CT scanning capabilities.” [Lee] On the other hand, “CT becomes a source of concern to the medical community from the perspective of increased cost and radiation dose to the patient population.” [Oh] This has led to studies of CT utilization. Research has included a number of provider related factors, including provider experience and gender. The purpose of this study was to look at the relationship of overall CT utilization, defined as the number of studies per 100 patients, by provider experience, gender and directorship experience.

The purpose of this study was to look at the relationship of attending emergency physician experience, gender, and department director experience to the percent overall utilization of CT scans. The data was part of ongoing administrative and management work of the department of emergency medicine. The data collected was from a six month period, from January 1, 2016 to June 30, 2016, comprising approximately 74,000 patient visits. CT scan percent utilization was defined as the total number of ED CT scans ordered per 100 patient visits. Department director experience was defined as current.

There were 30 attending emergency physicians in the cohort. Data was coded after entry into the database. The overall CT utilization was 31.8%, with a minimum of 17% and a maximum of 52% [95% CI 28.9-34 %]. The range was 35%. The median (31.5%) was almost identical to the mean, suggesting a normal distribution of the data [Table 1]. This was confirmed with the Anderson-Darling statistic. The standard deviation was 7.62 and the variance was 58.12%. There was a 205% difference between the utilization rates of the highest and the lowest provider. 

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