The Impact of a Preauthorization Policy on the After-hours Utilization of Emergency Department Computed Tomography Imaging

Published:February 29, 2016DOI:https://doi.org/10.1016/j.acra.2015.11.016

      Rationale and Objectives

      We evaluated the effects of a streamlined emergency department (ED) policy for CT ordering, pre- and postimplementation, on the completed imaging study rates of all after-hours computed tomography (CT) studies. The study hypothesis was that a streamlined CT ordering process would increase the utilization rates of ED CT.

      Materials and Methods

      A prospective cohort study was used to estimate the effect of enhancing a preauthorization policy for after-hours CT studies requested through the ED, performed between January 1 and June 30, 2013, and the postimplementation period, performed between January 1 and June 30, 2014. Inclusion criteria were all CT chest, CT abdomen/pelvis, musculoskeletal, neurological, and neuroangiographic examinations performed by ED physicians on adult patients. Pre- and postintervention examination imaging study rates were compared.

      Results

      The period following implementation of the preauthorization policy was associated with a statistically significant increase in utilization for most subtypes of CT examinations (CT chest, CT abdomen/pelvis, and musculoskeletal CT studies), with the exception of neurological examinations, which showed a significant decrease.

      Conclusions

      This study demonstrates a trend toward increased utilization of CT resources after implementation of an ED preauthorization policy with most study types showing significantly increased utilization. In the case of neurological examinations, a potential “substitution effect” was observed, whereby the rates of neuroangiographic studies showed a marked increase, offsetting the decrease in general neurological examinations performed. Departments considering implementation of preauthorization policies should weigh carefully the benefits of ED workflow efficiencies against the potential harms of increased CT use.

      Key Words

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      References

        • Shahi V.
        • Brinjikji W.
        • Cloft H.J.
        • et al.
        Trends in CT utilization for pediatric fall patients in US emergency departments.
        Acad Radiol. 2015; 22: 898-903
        • Brinjiki W.
        • Kallmes D.F.
        • Cloft H.J.
        Rising utilization of CT in adult fall patients.
        AJR Am J Roentgenol. 2015; 204: 558-562
        • Stanley R.M.
        • Hoyle Jr, J.D.
        • Dayan P.S.
        • et al.
        Emergency department practice variation in computed tomography use for children with minor blunt head trauma.
        J Pediatr. 2014; 165: 1201-1202
        • Ahn S.
        • Kim W.Y.
        • Lim K.S.
        • et al.
        Advanced radiology utilization in a tertiary care emergency department from 2001 to 2010.
        PLoS ONE. 2014; 9: e112650
        • Levin D.C.
        • Rao V.M.
        • Parker L.
        • et al.
        Continued growth in emergency department imaging is bucking the overall trends.
        J Am Coll Radiol. 2014; 11: 1044-1047
        • Runde D.
        • Shah K.
        • Naraghi L.
        • et al.
        Computed tomography utilization rates after the placement of a scanner in an emergency department: a single-center experience.
        Emergency. 2014; 21: 473-478
        • Pearce M.S.
        • Salotti J.A.
        • Little M.P.
        • et al.
        Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study.
        Lancet. 2012; 380: 499-505
        • Kim Y.
        • Kang G.
        • Moon S.-B.
        Increasing utilization of abdominal CT in the Emergency Department of a secondary care center: does it produce better outcomes in caring for pediatric surgical patients?.
        Ann Surg Treat Res. 2014; 87: 239
        • Chen Y.A.
        • Gray B.G.
        • Bandiera G.
        • et al.
        Variation in the utilization and positivity rates of CT pulmonary angiography among emergency physicians at a tertiary academic emergency department.
        Emerg Radiol. 2014; 22: 221-229
        • Carnevale T.J.
        • Meng D.
        • Wang J.J.
        • et al.
        Impact of an emergency medicine decision support and risk education system on computed tomography and magnetic resonance imaging use.
        J Emerg Med. 2015; 48: 53-57https://doi.org/10.1016/j.jemermed.2014.07.033
        • Medical Imaging | CIHI. cihi.ca
        Medical imaging.
        (Available at:) (Accessed August 5, 2015)
        • Lehnert B.E.
        • et al.
        Analysis of Appropriateness of Outpatient CT and MRI Referred From Primary Care Clinics at an Academic Medical Center: How Critical Is the Need for Improved Decision Support?.
        J Am Coll Radiol. 2010; 7: 192-197
        • Brenner D.J.
        • Hall E.J.
        Computed tomography—an increasing source of radiation exposure.
        N Engl J Med. 2007; 357: 2277-2284
        • Broder J.
        • Fordham L.A.
        • Warshauer D.M.
        Increasing utilization of computed tomography in the pediatric emergency department, 2000–2006.
        Emerg Radiol. 2007; 14: 227-232
        • Dhanoa D.
        • Burton K.R.
        • de Tilly L.N.
        • et al.
        Effect of a preauthorization policy on the utilization rate of after-hours emergency department neuroradiology computed tomography.
        CJEM. 2013; 15: 161-166