Emergency medicine physician-researchers at the University of Cincinnati have shown that a targeted quality improvement campaign can safely reduce unnecessary head and cervical spine (neck) computed tomography (CT) scans in low-risk trauma patients — with no downside.
In a study published recently in the Western Journal of Emergency Medicine , co-senior authors David Thompson, MD , and Anita Goel, MD , along with colleagues, reported that emergency departments at the University of Cincinnati Medical Center and West Chester Hospital avoided more than 3,500 unnecessary CT scans, saving patients more than $6 million in healthcare costs and avoiding more than 14,000 hours of waiting time and significant radiation exposure. The campaign identified no patient harm, and the data review found no missed injuries, confirming the approach's safety.
"UC physicians are committed to providing the best possible care and to continuously improving it," said Thompson, an associate professor of clinical emergency medicine and the director of quality improvement and patient safety in the College of Medicine 's Department of Emergency Medicine .
What did UC's CT scan reduction campaign achieve?
Estimated 3,542 head and cervical spine CT scans avoided
$6.2 million in patient healthcare costs saved (at ~$1,750 per CT)
14,168 hours of patient waiting time saved (at ~4 hours per scan)
6,021.4 millisieverts (mSv) of radiation avoided — roughly 2,000 years of typical background radiation for one person
Zero patient harm identified in safety review
Guiding decisions
In the emergency department, clinical decision rules help providers determine who may need a head or neck CT scan. They are core to emergency medicine training and practice, Thompson explained, and to standards of care at UC and nationwide.
The UC effort included continuing education sessions for emergency medicine providers that emphasized the CT scan decision rules and the research behind them. The CT decision rules were embedded in the electronic health record that is used to order patient testing and encourages clinicians to order tests appropriately.
"We do not miss serious injuries if you follow these guidelines," said Thompson. "There is no downside. Indeed, we did not find a single missed injury when we reviewed our data."
The effort also included educating patients, particularly those who believed they needed a CT scan despite a doctor's determination that they did not. Handouts were created to reassure them.
"Not everyone with a head or neck injury needs a CT scan. Some do; some don't," said Thompson. "We strive to provide the right care for every patient, and we have the tools to make those decisions."
Some head and neck trauma patients, including some with concussions, are considered low risk. High-risk trauma indicators include falls from height, ejection from motor vehicles, limb weakness or numbness, blood in the ear, vomiting, or confusion.
Research outcomes
By the end of the 23-month campaign, all outcome measures showed a reduction in the rate of head and cervical spine CT scans at both UC Medical Center and West Chester Hospital. No missed injuries were identified, confirming that the avoided scans were medically unnecessary.
"The doctors and the patients really want the same thing here," said Thompson. "We know patients want the highest quality care possible, and we are committed to providing the right testing and the right care needed in each situation."
High-volume hospital
As the Greater Cincinnati region's only academic medical center and Level I adult trauma center, UC Medical Center is a major tertiary care center and a high-volume hospital. The emergency department has 81 patient beds, which Thompson said are almost always at capacity — demonstrating that evidence-based imaging reduction can drive real-world quality improvements even in the busiest clinical settings.
"Achieving these decreases in such a high-volume setting makes the results particularly significant. This project was a huge win-win for doctors and patients," said Thompson.
UC study collaborators include co-senior author Anita L. Goel, MD, associate professor of clinical emergency medicine; co-first authors Jude C. Luke, emergency medicine resident physician, and Rebecca N. Kubick, medical student; Heidi J. Sucharew, emergency medicine research professor; Natalie E. Kreitzer, associate professor of clinical emergency medicine and interim vice chair of research in the Department of Emergency Medicine; and Kayla Winkler and Mary L. Giles from the UC Health Office of Performance Improvement.
