According to a study from researchers at the Perelman School of Medicine at the University of Pennsylvania, an EMR tool that tallies patients' previous radiation exposure from CT scans can help reduce potentially unnecessary use of the tests among emergency room patients with abdominal pain. When the tool is in use, researchers say patients are 10 percent less likely to undergo a CT scan, without increasing the number of patients who are admitted to the hospital.
According to the researchers, abdominal pain is the most common reason why people seek care in emergency rooms in the United States, accounting for 10 million visits each year. The symptoms, they say, may be caused by myriad problems, which can be fixed with a single dose of an over-the-counter drug to those that could prove life-threatening within hours. This is why physicians in the ER lean on tests like CT scans.
The researchers say since the mid 1990s, the use of CT scans to diagnose ER patients has increased ten-fold. Today, 14 percent of all emergency room patients get scanned, which experts often point to as a contributor to ballooning healthcare costs.
"Most patients with abdominal pain aren't in major danger, but some of the conditions that are on the list of things we consider as causes can be fatal within a short amount of time," said Angela M. Mills, M.D., an assistant professor of emergency medicine and medical director of the emergency department at the Hospital of the University of Pennsylvania, said in a statement. "We need to be sure about our diagnosis in order to keep patients safe, but we need to balance the risks of giving a test like a CT scan with the chance that the test will truly provide us with information we could not get in some other way with less risk to the patient."
The tool embedded within patients' EMRs walked physicians through a series of questions that served as checks and balances for their decision to order a CT scan to investigate a patient's abdominal pain. For instance, one of the questions was on what diagnosis they were trying to look for (from appendicitis to colitis to an ovarian cyst or tumor), and how likely they thought it was that the patient actually had that problem. If a resident ordered that rest, it had to be approved by an attending physician before the patient could receive the scan.
The researchers studied 11,176 patients seen in two Penn Medicine emergency rooms between July 2011 and March 2012. Prior to implementing the new "accountability tool," 32.3 percent of patients seen received CT scans. After its use was adopted, the number dropped to 28 percent. With adjustments, the researchers determined that patients were 10 percent less likely to undergo a CT scan after the tool was built into the EMR. The patients were no more likely to be admitted to the hospital — a common occurrence when a diagnosis remains unclear — after adoption of the tool.
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