Medical imaging for emergency department patients is necessary only when accompanied by red flags that point to serious underlying conditions, said presenter Adam Min from the University of British Columbia.
"Since these conditions are extremely rare, indiscriminate medical imaging for these patients has a low yield," Min said. "Guideline dissemination and physician education, on their own, have been shown to have limited efficacy in influencing physician behavior, and inappropriate imaging of [lower-back pain] patients in the ED is still prevalent."
However, in March 2015 the institution launched a clinical decision-support (CDS) software tool for lumbar x-ray, CT, and MRI orders in the ED that included a checklist of red flags for lower-back pain. The application was embedded in the electronic order-entry form for lumbar imaging, and ED physicians were required to select at least one red flag from the checklist to justify an imaging request.
After implementation, imaging rates for lower-back pain dropped significantly, as did variation in ordering rates among individual physicians. A secondary analysis also found no significant increase in harmful outcomes as a result of CDS implementation and its associated reduction in medical imaging rates, according to Min.
"Our study shows that CDS can effectively influence physician decision-making with respect to [lower-back pain] imaging in a busy, urban ED," Min told AuntMinnie.com. "Its use in the order-entry form for lumbar imaging resulted in greater compliance with established guidelines, a safe reduction in the rates of inappropriate imaging, and improved cost-effectiveness of care."
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