REDUCING IONIZING RADIATION EXPOSURE FROM CHEST CT IN THE EVALUATION - PowerPoint PPT Presentation

REDUCING IONIZING RADIATION EXPOSURE FROM CHEST CT IN THE EVALUATION OF THE INJURED CHILD: A QUALITY IMPROVEMENT PROJECT Megan Strawhacker, RN; Stephanie Haley-Andrews, RN; Genie Roosevelt, MD, MPH; Craig Gravitz, RN; Claudia Kunrath, MD; Denis Bensard, MD

• NoDisclosures

• A child’s risk of developing cancer from radiation exposure is estimated to be as high as 1/500 • Children exposed to higher radiation doses than adults • Chest CT did not change management of the patient • Chest CT recommended - abnormal mediastinal silhouette

HYPOTHESIS • Reduce the # of Chest CTs and radiation exposure by: • Provider Education • Imaging Guidelines • Robust Performance Improvement Program • No missed significant or life threatening thoracic injury

METHODS • Retrospective study • 2010-2013 – Injured children under the age of 15 who underwent Chest CT or Chest/Abdomen/Pelvis CT for blunt trauma • 53 patients met criteria • Provider Education initiated in 2012 • Imagine Guideline implemented in 2013 • Audit filter was developed • Chest CTs reviewed monthly at Pediatric Trauma Committee

IMAGING GUIDELINE

RESULTS - DENVER HEALTH MEDICAL CENTER

RESULTS – STATE OF COLORADO

DENVER HEALTH & STATE OF CO Denver Health Colorado 2010 9.00% 10.8% 2011 12.6% 9.8% 2012 7.3% 9.5% 3.3% 2013 6.5%

COST SAVING BENEFITS • Costs of CT scan • 71250 w/o contrast $1,779.00 • 71260 w contrast $2,235.08 • 71270 w w/o contrast $2318.22 • Diagnostic Related Groups (DRG) • Admitted patients - CT scan gets lumped into DRG • Money deducted from reimbursement

SUMMARY • Selective CT imaging decreased the amount of ionizing radiation exposure to children • No missed life threatening thoracic injuries • Education of providers reduced imaging but implementation of imagining guidelines with monitoring was more effective • Multidisciplinary PI program contributed to success

WHERE DO WE GO FROM HERE? • Abdominal/Pelvis CTs – imagining guideline • Head CTs – imaging guideline based on PECARN • Continue education to curtail liberal imaging of injured children • Monthly webinars • Annual trauma & emergency medicine conference

Megan.strawhacker@dhha.org THANK YOU!