Mandates to shift our care delivery systems from a focus on quality or cost to one of value is challenging. Unnecessary and expensive diagnostic tests contribute to wasteful spending that does little to improve patient outcomes. Poor understanding of test ordering behaviors may further contribute to current practice patterns. Engaging trainees and influencing their practice behaviors offers an important potential educational strategy.
To evaluate the impact of an educational awareness campaign on radiology test ordering practices.
According to data from the University Health System Consortium (UHC), in 2010 3040% of medical services at academic health centers ordered fewer radiology tests compared with our medical service (adjusted by number of patients), and 90% ordered fewer Chest XRays. To address this, we launched a campaign to raise awareness about radiology cost and utilization using complementary strategies. Educational interventions (e.g., emails, flyers, wall posters) targeted trainees and attendings on our academic teaching service. Posters were placed in areas with the most physician traffic, including charting rooms and locations for teaching rounds. Educational materials provided information on the number and costs of radiology tests ordered on our service last year, national benchmarks, and practical tips to guide ordering practices. A “radiology utilization” curriculum and facilitation guide was developed and sent to all attendings to lead educational discussions during teaching rounds. The facilitator guide instructed attendings to engage their teams and reflect upon the local data for radiology utilization, discuss the impact of unnecessary radiology test ordering on cost and patient care, and share strategies on improving the appropriateness of test ordering practices. Initial findings from our intervention demonstrated that during the first month, significant reductions were noted in five out of the six radiology tests evaluated. We compared these to our baseline data from the previous two 2 years. Table 1 summarizes the preliminary data, adjusted for the number of patient days. We are continuing to track this data moving forward along with other administrative data to monitor for unintended consequences (length of stay and readmission rates).
Raising awareness and educating provider teams about the cost and utilization of radiology tests can lead to changes in testordering behaviors. Our intervention was easy to implement, benefited from collaboration between our Department, Division of Hospital Medicine, and Residency program, and required no sophisticated equipment or resource investment. The ability to provide feedback to providers and teams, particularly around specific clinical conditions, would potentially advance these efforts to further engage and achieve more costeffective care. The same principles could be applied to broaden efforts that generate true value for hospitalized patients.
Table 1Radiology Utilization (number of tests adjusted by patient days)
To cite this abstract:Quinn K, Soni K, Mourad M, Neeman N, Sehgal N, Ranji S. The Impact of a Radiology Utilization Campaign on Test Ordering Practices. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97715. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/the-impact-of-a-radiology-utilization-campaign-on-test-ordering-practices/. Accessed September 18, 2019.