Getting Imaging into Focus
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While falling is a serious issue throughout hospital systems, it is particularly of interest in radiology programs, but sometimes overlooked. St. Joseph’s evaluates patients for their risk of falling, and then compiles a list of medications the patient takes before the radiologist injects contrast media to identify potential contraindications. After that occurs, hospital officials provide patients with “instructions on any possible changes to their medications that may result from the contrast injections,” Hart says.
“We work hard to implement procedures that optimize the safety of every patient in our department and, equally as important, we audit our processes to ensure that they are working,” he adds.
For some hospital systems, there have been other CT scan concerns. In 2008, Memorial Medical Center of West Michigan had the highest rate of scans in the nation, running 89% of its Medicare chest CT scans through what is known as “double” scans, far above what academic centers report, somewhere around 1%, according to The New York Times. In a double scan, patients get two imaging tests consecutively, one without dye and the other with dye injected into their veins. Small community hospitals such as Memorial Medical Center had been grappling with the scanning issues after disclosures in the media about problems. While experts say almost all chest problems can be properly diagnosed with a single scan, some physicians still value the double scans for gathering the most information possible. Hospitals and radiologists are paid more for the double scans, so there may be a reluctance to change habits.
“With changing trends and sensitivity for CT, the questions came up about whether there was a need, and there was a conclusion that transitions had to be made in how we did scans; we didn’t want to be an outlier,” says Williams. “When you do this, you start looking at things very closely, from education to our physicians to protocols—the way we do our program,” he says.
A major improvement came after the hospital created a monitoring committee to review specific problems, Williams says.
“We started investigating the data and found that changes had to be made,” Williams says. One of the issues was that the hospital instituted both scans, especially for patients who had to travel long distances, with the idea being “one-stop shopping and that was the trend years ago.”
Since 2008, Memorial Medical Center lowered its rate for double scans to 42.4% in 2010 and 3% in the first part of 2011, according to Williams.
Through in-house subcommittees, the hospital improved its communication system specifically about the scans. “The radiologists talk to the other physicians and talk about what might be the most reasonable and acceptable approaches,” Williams says. “We did the turnaround by really looking at the entire program and educating the physicians. You want to serve the patient the best way you possibly can.”
He says the hospital is still compiling data on potential outcomes, but said the latest protocols ensured “tighter screenings to meet appropriate criteria.” Williams adds that reimbursements were not impacted by changes. “Because we had a dose reduction agenda in place already, the radiation doses were in the safety range.” Even with the so-called double scans, a consultant physicist who reviewed the program found that the “radiation dose was negligible,” Williams says. “But when you see something and there are questions, you look at every angle and make appropriate changes to meet the shifting criteria.”
In revising the protocols, “there was a tremendous turnaround. We were already trending in that direction when the adjustments were made,” Williams says. “We found, with the cooperation of everyone involved, it turned around in a much shorter time frame than we thought it would.”
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