ED Preauthorization for CT May Increase Use

Emergency departments (EDs) may use more CT resources after implementation of an ED preauthorization policy, according to a study published in Academic Radiology.

Researchers from Canada performed a prospective cohort study to determine if a streamline ED policy for CT ordering would affect after-hours imaging study rates in the ED.

The study was performed between January 1, 2013 and June 30, 2013, and the postimplementation period was performed between January 1, 2014 and June 30, 2014. The 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.

The results showed that while the use of CTs associated with neurological studies went down following implementation of the preauthorization policy, there was a statistically significant increase in use of CTs of the chest, abdomen/pelvis, and musculoskeletal system.[[{"type":"media","view_mode":"media_crop","fid":"47161","attributes":{"alt":"CT","class":"media-image media-image-right","id":"media_crop_3604230092034","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5534","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 135px; width: 180px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©nav/Shutterstock.com","typeof":"foaf:Image"}}]]

The researchers concluded the decrease in CTs associated with neurological exams may have resulted in a “substitution effect,” which was in a marked increase of neuroangiographic studies among the patients. “Departments considering implementation of preauthorization policies should weigh carefully the benefits of ED workflow efficiencies against the potential harms of increased CT use,” the authors wrote.