How Many Slices Do You Really Need?
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Being an early adopter of the latest technology is not enough; today's organizations must know how to use it effectively, as well.
As imaging equipment keeps advancing, hospitals and physicians are under increasing pressure to ensure they are purchasing new equipment at the right time and, more important, using tests appropriately.
Diagnostic errors cause 40,000 to 80,000 preventable hospital deaths annually, according to the Journal of the American Medical Association's March 2009 report, "Diagnostic Errors—The Next Frontier for Patient Safety." In addition, the federal government is looking for ways to lower what it pays for imaging given that Medicare's annual price tag more than doubled between 2000 and 2006, topping $14 billion annually.
In the past 15 years, the equipment, and to a certain degree, the manufacturers have created a market base that "tends to a situation where tests are seeking uses," says Chris Sistrom, MD, MPH, associate chair, the University of Florida's radiology department.
Do we need a new MRI?
When purchasing imaging equipment, Sanford USD Medical Center and Sanford Children's Hospital, part of the 23-hospital Sanford Health system in Sioux Falls, SD, have taken a conservative approach. "We are mostly interested in patient safety, quality of the images, and making sure that we have up-to-date and upgradable technology," says President and CEO Charles P. O'Brien, MD. "We want to make sure also that we're not out ahead on the bleeding edge all of the time."
When ultrahigh-field-strength 3T magnetic resonance imaging equipment hit the market a few years ago and another health system in town put one in its new imaging center, Gale Wynia, Sanford's radiology director, faced some tough questions. Namely, should Sanford purchase one, as well? "The protocols had not been established yet to the point where we really needed to invest the money in 3T and the physicians had not asked for it," says Wynia. So the organization chose to wait until this past year when it installed a 3T MRI for breast imaging.
Yet when Sanford built its 146-licensed-bed children's hospital, it opted to step out ahead and install new low-dose CT technology that can significantly reduce a child's radiation exposure. The technology works with the 64-slice CT scanner to reduce radiation levels by 30% to 40%.
The pediatricians and pediatric subspecialists helped drive that decision, says Randy Bury, Sanford's chief operating officer. They said, "It is the coming trend, and pretty soon if you are going to call yourself a children's hospital you better have this piece of equipment in it."
The tougher choice was whether to modify the CT scanner in the emergency department, as well, Bury says. "We put ourselves in the position of having two standards of care for pediatric patients on our campus, so we upgraded it."
When purchasing new technology, organizations should:
- Answer the fundamental questions about quality, safety, and need.
- Determine whether payers will recognize the technology as an improve- ment in care and cover it, says Bury.
- Avoid purchasing technology just to keep up with competitors. Any time organizations are distracted from quality and efficiency because someone has scared them about their influence in the market, it will likely end in a mistake, says O'Brien.
- Use physician committees to determine whether you really need to purchase "this latest gizmo that is polka-dotted and just for lefthanders," says O'Brien. "It is objectivity, not reacting emotionally or on the advice of one physician, that has served us well over the years."
Is this the right test?
The next challenge organizations face is determining whether they are using new imaging equipment effectively. "You can't expect ordering physicians to know the full range and all of the imaging capabilities of these imaging devices," says O'Brien.
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