Appropriate use of CT for patients presenting with suspected renal colic: a quality improvement study

[摘要] Introduction CT use for renal colic has increasedcosts, radiation exposure and frequently does not altermanagement. Consequently, choosing wisely (CW)recommends avoiding CT imaging of otherwise healthypatients younger than 50 years presenting with symptomsof recurrent, uncomplicated renal colic. We evaluated theutilisation of CT imaging for this subgroup of patients andsubsequently implemented a quality improvement initiativewith an aim to reduce unnecessary radiation exposure.Methods A retrospective chart review was performed forall patients younger than 50 years who visited SunnybrookHealth Sciences Centre emergency department (ED)between December 2015 and May 2016 with a dischargediagnosis of renal colic. After the audit period, emergencyphysicians were engaged to perform a root cause analysisand a driver diagram was developed. In December 2016,a clinical decision tool was introduced to standardisethe imaging for patients with presumed renal colic. InMay 2017, a separate electronic order was created forlow-dose CT for renal colic, including a prompt to remindclinicians of the CW recommendation. The impact of thesechanges was measured over 15 months.Results Over the initial audit period, 17/63 (27%) of ourtarget population received a CT to rule out renal colic.Many patients received multiple CT scans for renal colicduring past ED visits, while one received a total of 13 CTs.At the time of our interventions, the baseline rate of CTscans in our target population was 37%, which reduced to29% after our project began.Conclusion CT is often used as an initial diagnosticmodality for suspected recurrent renal colic despitecurrent guidelines. While this initiative caused only amodest change in management, it led to the introductionof a new low-dose CT scan order specifically to reduceradiation exposure in patients at risk for repeat scans.

[学科分类] 药学