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By BrainScope
on April 06, 2023

 

Reduction of low clinical value head CTs is a recognized quality initiative among clinical associations, hospitals, and the government. However, in the Emergency Department (ED), over 80% of mild head injured patients still receive a head CT although >90% are found to be negative.1  Nearly 30% of emergency physicians self-reported that they continue to order head CTs for mild head injured patients because of concern for serious diagnosis and/or pressure to meet patient/family expectations.

By BrainScope
on April 06, 2023

Nearly all emergency departments (EDs) are experiencing long wait times, patient boarding, and high rates of patients left without being seen (LWBS). Pre-pandemic, the national average for LWBS was 1.1%. Post pandemic, the national average has more than doubled to 2.5%, reaching as high as 10% in some hospitals.1 With more than half of all hospital patients coming through the ED, these factors directly impact patient outcomes, experience, and hospital revenue.

By BrainScope
on April 06, 2023

In 2012, the American College of Emergency Physicians (ACEP), like other specialty societies, began a conversation with its members to develop five “Choosing Wisely®” recommendations. One of their first recommendations was to avoid low-value Computed Tomography (CT) scans of the head in patients with minor head injury.  ACEP’s multistep process began with input from its Cost-Effective Task Force (Task Force), which administered a survey to ACEP members asking for strategies to “reduce costs and improve value in Emergency Medicine.” The Task Force determined that the evidence was clear; patients with minor head injury that are low risk for intracranial bleeding or skull fracture by decision rules would benefit from a conversation with their clinician on the utility of a head CT.1

By BrainScope
on April 06, 2023

For most mild head injured patients that seek care at the Emergency Department a head CT is the traditional assessment tool used. While this makes sense as providers want to rule out the likelihood of the most serious diagnosis (intracranial hemorrhage), which in over 90% of patients scanned will be negative. A single head CT delivers the equivalent radiation as 20 chest X-rays, increasing an individual’s lifetime risk of cancer.

By BrainScope
on April 06, 2023

Radiation reduction is a top quality metric for improving patient outcomes. One example can be seen with the HCA system and their Radiation Right program. This program promotes considering alternative exams that can still meet the patient needs while minimizing exposure to ionizing radiation.  Choosing Wisely® and the Centers for Medicare and Medicaid (CMS) also have initiatives to reduce radiation exposure. These initiatives are specifically aimed at reducing radiation in the mild head injured patient population, as over 80% of these patients receive a head CT with over 90% of the results negative for a brain bleed.