emergency medicine Archives - The Imaging Wire

We all know it happens – medical imaging scans of questionable clinical value, performed not to improve patient diagnosis but to defend clinicians in the event of malpractice litigation. A new study in AJR supports the idea that defensive medicine is driving up imaging use by finding a link between malpractice reform and lower emergency imaging utilization.

The proliferation of imaging technology throughout the healthcare enterprise – and especially in the emergency setting – gives clinicians a powerful tool that’s just too tempting not to use.

Head CT scans can quickly rule out patients who might have a hemorrhagic stroke, for example, while cardiac CT angiography is showing its value for working up patients with chest pain.

But with great power comes great responsibility. Unnecessary imaging not only drives up healthcare costs but can expose patients to additional radiation as well as complications from working up suspicious findings.

Medical-legal experts speculate that malpractice reform through tools such as damage caps could tamp down defensive medicine by limiting physicians’ legal exposure to lawsuits in the event they make a mistake.

In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute tested the idea by analyzing 630k Medicaid encounters for patients with headache presenting to the emergency department in 2019.

They then correlated head and neck imaging volume to various factors that could influence utilization, including whether states had implemented tort reform.

Their analysis discovered that emergency imaging utilization was less likely to occur…

In states with laws on “several liability” (in which parties are only responsible for their own share of damages) (OR = 0.68).
In states with malpractice damage caps (OR = 0.79).
In states with greater mean malpractice payment (although the effect size was minimal; OR = 0.99).

A couple other interesting findings included…

Referring physicians other than emergency medicine were far more likely to order more imaging (OR = 8.45).
Facilities with fewer than 100 beds were less likely to order imaging (OR = 0.65).

The Takeaway

The new findings linking malpractice reforms with lower emergency imaging use confirm what many of us have already suspected. Whether they lead to health policy reforms remains to be seen.

Using POCUS in the emergency department (ED) to scan patients with suspected deep vein thrombosis (DVT) cut their length of stay in the ED in half.

Reducing hospital length of stay is one of the holy grails of healthcare quality improvement.

It’s not only more expensive to keep patients in the hospital longer, but it can expose them to morbidities like hospital-acquired infections.

Patients admitted with suspected DVT often receive ultrasound scans performed by radiologists or sonographers to determine whether the blood clot is at risk of breaking off – a possibly fatal result.

But this requires a referral to the radiology department. What if emergency physicians performed the scans themselves with POCUS?

To answer this question, researchers at this week’s European Emergency Medicine Conference presented results from a study of 93 patients at two hospitals in Finland.

From October 2017 to October 2019, patients presenting at the ED received POCUS scans from emergency doctors trained on the devices.

Results were compared to 135 control patients who got usual care and were sent directly to radiology departments for ultrasound.

Researchers found that POCUS reduced ED length of stay from 4.5 hours to 2.3 hours, a drop of 52%.

Researchers described the findings as “convincing,” especially as they occurred at two different facilities. The results also answer a recent study that found POCUS only affected length of stay when performed on the night shift.

The Takeaway
Radiology might not be so happy to see patient referrals diverted from their department, but the results are yet another feather in the cap for POCUS, which continues to show that – when in the right hands – it can have a big impact on healthcare quality.

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