Less ER image testing saves money, improves patient safety

In an effort to reduce healthcare costs and improve patient safety, some hospitals and physicians want to use less high-tech imaging in emergency rooms (ER), and look for simpler, lower-risk diagnostic techniques, the Wall Street Journal reported.

Excessive diagnostic testing is expensive and could have negative consequences--such as false positives, which lead to high doses of radiation, dye injections and other unnecessary treatment, said David Newman, M.D., director of clinical research in the department of emergency medicine at Mount Sinai Hospital in New York City.

"A doctor's touch can often be more revealing, more helpful and more healing than any scan," Newman told WSJ. "At the bare minimum, a comprehensive history and physical examination, a typically benign exercise that creates bonding and occasionally makes diagnoses, should be a gateway to testing, allowing physicians to avoid the harms and excesses that generally accompany technological testing."

Physician groups around the country support the movement. The American College of Emergency Physicians joined the American Board of Internal Medicine's Choose Wisely campaign last year and recommended ER doctors avoid CT scans for patients with minor head injuries who are at low risk for skull fracture and brain bleeds. Instead, doctors should perform a thorough physical exam and patient history to safely determine patient risk, according to the article.

Brigham and Women's Hospital doctors consult "decision support" computer tools to determine the most appropriate imaging tests to use based on the latest scientific evidence, said Jeremiah Schuur, M.D., an ER physician at the Boston hospital. Consulting the computer tool for CT chest scans for pulmonary embolus and CT head scans for trauma led to a 33 percent reduction in CT scan use per 1,000 patients who visited the ER in the past five years, according to the article.

In an era of increased medical liability, many ER doctors struggle to find a balance between over-testing and missing a diagnosis, and they worry that reducing medical-imaging could affect quality of care, the WSJ reported. However, a study published in JAMA Internal Medicine found that hospitals that used medical imaging among patients presenting with chest pain didn't see lower readmission rates within the subsequent month.

Research shows ERs can save money and avoid repeat imaging through health information exchanges, FierceMedicalImaging previously reported.

To learn more:
- here's the WSJ article