The purpose of our
Quality Improvement (QI) project was to evaluate the effectiveness of radiology-led
didactics on efficiency and ordering practices in the emergency department.
Residents of the emergency medicine (EM) program at Downstate Medical
Center/Kings County Hospital (postgraduate years 1 - 4) participated in a
didactic lecture series during the first two months of the 2013 academic year.
Two fifteen-minute lectures with a question and answer session were designed
to focus on radiation risk, American College of Radiology (ACR) appropriateness
criteria and the department of radiology’s policies. A short survey
questionnaire that included questions on ACR appropriateness criteria,
radiology experiences and opinions/attitudes regarding radiology was
distributed and analyzed before and after the didactic series. The average
score for the knowledge-based technical questions on ACR appropriateness
criteria was 60.5% initially and 76.4% post-lecture with an overall improvement
of 25%, which was statistically significant (p < 0.0001). Following a short
didactic lecture series, EM residents showed significant improvement of their
knowledge of appropriate image utilization on the post-lecture survey. This
highlights the need for dedicated radiology-led lecture series for EM
residents. This type of program could be implemented yearly and expanded to
other departments to promote interdepartmental commuication, increases
radiology awareness, improves ordering practices and encourages appropriate
imaging utilization.
References
[1]
Eng, J., Mysko, W.K., Weller, G.E.R., et al. (2000) Interpretation of Emergency Department Radiographs: A Comparison of Emergency Medicine Physicians with Radiologist, Residents with Faculty, and Film with Digital Display. American Journal of Roentgenology (AJR), 175, 1233-1238. http://dx.doi.org/10.2214/ajr.175.5.1751233
[2]
Gunderman, R.B., Bettmann, M. and Davis, L.P. (2007) Promoting Educational Innovation: Lessons from the Request for Proposals for ACR Appropriateness Criteria Usage in Medical Education. Journal of the American College of Radiology, 4, 919-924. http://dx.doi.org/10.1016/j.jacr.2007.07.003
[3]
Bautista, A.B., Burgos, A., Nickel, B.J., et al. (2009) Do Clinicians Use the American College of Radiology Appropriateness Criteria in the Management of Their Patients. American Journal of Roentgenology (AJR), 192, 1581-1585. http://dx.doi.org/10.2214/AJR.08.1622
[4]
Studdert, D.M., Mello, M.M., Sage, W.M., et al. (2005) Defensive Medicine among High-Risk Specialist Physicians in a Volatile Malpractice Environment. The Journal of the American Medical Association (JAMA), 293, 2609-2617. http://dx.doi.org/10.1001/jama.293.21.2609
[5]
Dym, R.J., Burns, J. and Taragin, B.H. (2013) Appropriateness of Imaging Studies Ordered by Emergency Medicine Residents: Results of an Online Survey. American Journal of Roentgenology (AJR), 201, W619-W625. http://dx.doi.org/10.2214/AJR.12.10487
[6]
Griffey, R. and Sodickson, A. (2009) Cumulative Radiation Exposure and Cancer Risk Estimates in Emergency Department Patients Undergoing Repeat or Multiple CT. American Journal of Roentgenology (AJR), 192, 887-892. http://dx.doi.org/10.2214/AJR.08.1351
[7]
News Releases (2013) SGR Replacement Policy Draft Endorses Use of Appropriateness Criteria in Medical Imaging Exam Ordering.
[8]
Taragin, B.H., Feng, L. and Ruzal-Shapiro, C. (2003) Online Radiology Appropriateness Survey: Results and Conclusions from an Academic Internal Medicine Residency. Academic Radiology, 10, 781-785. http://dx.doi.org/10.1016/S1076-6332(03)80123-X