Abstract
Objective
The purpose of our study was to audit the clinical appropriateness of the prescriptions of whole body CT (WB-CT), PET–CT and chest X-rays (CXRs) performed at Tor Vergata University Hospital in the inpatient setting.
Materials and methods
WB-CT, PET–CT and CXRs examinations were retrospectively analysed in the period between January and December 2014. CXR examinations were divided into bedside CXRs and traditional CXRs. The appropriateness of the examinations was defined according the American College of Radiology Appropriateness Criteria. Inappropriate examinations were divided into six inappropriateness categories in accordance with the European Union Medical Imaging Guidelines.
Results
Appropriateness was suboptimal for all analysed techniques CXRs (A = 38%, I = 62%); bedside CXRs (A = 45%, I = 53%); WB-CT (A = 45%, I = 55%); PET–CT (A = 48%, I = 52%). With respect to WB-CT the highest rate of inappropriate imaging prescriptions came from the haematology clinical operative unit (OU) (44%) and emergency medicine (33%); with respect to PET–CT, the thoracic surgery OU (53%) and haematology OU (48%) showed the most inappropriate prescriptions. For CXRs, the percentage of inappropriateness was consistently distributed among all surgical OUs. For bedside CXRs, the largest inappropriate prescribers were the emergency medicine OU (48%), the cardiac surgery OU (58%), the intensive care OU (67%) and anaesthesia resuscitation OU (78%). The most represented classes of inappropriateness were 2, 3, 4 and 6.
Conclusions
The elimination of inappropriate prescriptions would result in an annual savings of approximately 390,000 Euro. An implementation plan to increase prescription appropriateness is under development by our group.
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References
Bullivan J, Corbett-Nolan A (2010) Clinical audit: a simple guide for NHS. Good Governance Institute (GGI). http://www.good-governance.org.uk/wp-content/uploads/2014/02/clinical-audit-a-simple-guide-for-nhs-boards-and-partners.pdf. Accessed January 2015
Ghirardini A, Cardone R, De Feo A et al (2012) Ministero della Salute. Manuale di formazione per il governo clinico: monitoraggio delle performance cliniche http://www.salute.gov.it/imgs/C_17_pubblicazioni_1984_allegato.pdf. Accessed January 2015
Marcosignori M, Lorenzini I, Benedetti A, Gabrielli B, Pomponio G (2012) Inappropriatezza prescrittiva delle colonscopie: un audit clinico. Evidence. Gimbe Foundation Vol. 4 Iss 8 e-1000030. http://www.evidence.it/articoli/pdf/e1000030.pdf. Accessed Feb 2016
Carpeggiani C, Marraccini P, Morales MA, Prediletto R, Landi P, Picano E (2013) Inappropriateness of cardiovascular radiological imaging testing; a tertiary care referral center study. Plos One. doi:10.1371/journal.pone.0081161 (Accessed Feb 2016)
ACR Appropriateness Criteria. http://www.acr.org/quality-safety/appropriateness-criteria. Accessed Jan 2015
EU guidelines for healthcare professionals who prescribe imaging investigations involving ionising radiation. http://ec.europa.eu/energy/nuclear/radioprotection/publication/doc/118_update_en.pdf. Accessed Jan 2015
Institute of Medicine (2012) Best care at lower cost: the path to continuously learning health care in America. http://iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx. Accessed Sept 2015
Kassing P, Duszak R (2013) Repeat medical imaging: a classification system for meaningful policy analysis and research Harvey Neimann Policy Institute. http://www.acr.org/research/health-policy-institute/neiman-report-index/brief-02-Repeat-medical-imaging. Accessed Mar 2015
Compoginis JM, Akopian G (2009) CT imaging in motorcycle collision victims: routine or selective? Am Surg 75:892–896
Richards JR, Derlet RW (1998) Computed tomography for blunt abdominal trauma in the ED: a prospective study. Am J Emerg Med 16:338–342
Millo NZ, Plewes C, Rowe BH, Low G (2011) Appropriateness of CT of the chest, abdomen, and pelvis in motorized blunt force trauma patients without signs of significant injury. AJR 197:1393–1398. doi:10.2214/AJR.11.6536
Jacobs DG, Sarafin JL, Marx JA (2000) Abdominal CT scanning for trauma: how low can we go? Injury 31(5):337–343
Mauro FR, Chauvie S, Paoloni F et al (2015) Diagnostic and prognostic role of PET/CT in patients with chronic lymphocytic leukemia and progressive disease Leukemia. 29(6):1360–1365. doi:10.1038/leu.2015.21
Conte MJ, Bowen DA, Wiseman GA, Rabe KG, Slager SL, Schwager SM, Call TG, Viswanatha DS, Zent CS (2014) Use of positron emission tomography-computed tomography in the management of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma. Leuk Lymphoma 55(9):2079–2084. doi:10.3109/10428194.2013.869801
Sim YT, Poon FW (2013) Imaging of solitary pulmonary nodule—a clinical review. Quant Imaging Med Surg 3(6):316–326. doi:10.3978/j.issn.2223-4292.2013.12.08
Bar-Shalom R, Valdivia AY, Blaufox MD (2000) PET imaging in oncology. Semin Nucl Med 30:150–185
Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK (2001) Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 21 285(7):914–924
National study by the Royal College of Radiologists (1979) Preoperative chest radiology. Lancet 2(8133):83–86
Rucker L, Frye EB, Staten MA (1983) Usefulness of screening chest roentgenograms in preoperative patients. JAMA 250(23):3209–3211
Graat ME, Choi G, Wolthuis EK, Korevaar JC, Spronk PE, Stoker J, Vroom MB, Schultz MJ (2006) The clinical value of daily routine chest radiographs in a mixed medical-surgical intensive care unit is low. Crit Care 10(1):R11. doi:10.1186/cc3955
Oba Y, Zaza T (2010) Abandoning daily routine chest radiography in the intensive care unit: meta-analysis. Radiology 255(2):386–395. doi:10.1148/radiol.10090946
Graat ME, Hendrikse KA, Spronk PE, Korevaar JC, Stoker J, Schultz MJ (2006) Chest radiography practice in critically ill patients: a postal survey in the Netherlands. MJ BMC Med Imaging. 18(6):8. doi:10.1186/1471-2342-6-8
White Paper (2009) Where can $700 billion in waste be cut annually from the U.S. Healthcare System? Thomson Reuters. http://healthcarereform.procon.org/sourcefiles/thomson_reuters_study_medical_waste_2010.pdf. Accessed Mar 2015
Ministero della Salute. Progetto Mattoni SSN (2007) Documento per la misura dell’appropriatezza delle prestazioni di specialistica ambulatoriale. http://www.salute.gov.it/imgs/c_22_attivitamattoni_5_documenti_documento_1_fileallegato.pdf. Accessed Mar 2015
Tricoci P, Allen JM, Kramer JM, Califf RM, Smith SC Jr (2009) Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA 301:831–841. doi:10.1001/jama.2009.205
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The study has been approved by the IRB and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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All patients gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study were omitted.
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Squillaci, E., Bolacchi, F., Scaggiante, J. et al. Inappropriateness of diagnostic imaging examinations in the inpatient setting: a case study research. Radiol med 122, 221–227 (2017). https://doi.org/10.1007/s11547-016-0708-4
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DOI: https://doi.org/10.1007/s11547-016-0708-4