Doctor-Patient Relationship is Key to Reducing CT Scan Overuse in ED

patient and doctor in the emergency room
In emergency department settings, overuse of computed tomography (CT) for minor head injury continues despite rigorously validated clinical decision rules like the Canadian CT Head Rule (CCHR). Medical experts say one in every three CT scans performed on patients with minor head injury is unnecessary. New research from Yale University has found that, amongst other factors, strengthening the doctor-patient relationship can help to optimise use of CT. The findings are reported in the journal Academic Emergency Medicine.

Guidelines such as the CCHR can assist emergency providers in assessing when a patient’s minor head injury should lead to a CT scan and further intervention. These guidelines have been tested and validated, but they are often ignored. For example, CT scans may be performed on patients with signs of concussion — even though CT does not help diagnose concussion but rather other risks such as bleeding.

The "disconnect" between CT guidelines and practice for minor head injury led Dr. Edward R. Melnick, assistant professor of emergency medicine, Yale School of Medicine, and colleagues to conduct a qualitative study that included focus groups and interviews with patients and providers, as well as clinical observations.

See Also: Study: CT Can Change ER Physicians' Diagnoses

The results show that a range of nonclinical factors influenced medical decisions leading to unnecessary scans. For providers, those factors included their own lack of confidence and experience, the influence of others (family members, other providers), and time constraints. For patients, empathic themes such as the doctor’s ability to listen and care for them were significant issues.

To address those factors and curb overuse of CT scans, Dr. Melnick's team identified several themes involving trust and bedside manner: patient engagement, listening, reassurance, identifying and addressing patient concerns, and managing patient anxiety.

“The doctor-patient relationship weighs heavily on the ability of the doctor and patient to be aligned in terms of whether a patient will understand and agree with the doctor’s recommendation,” Dr. Melnick explains. “When a doctor takes time to listen and care for a patient, and the patient sees the doctor cares, the patient is more willing to trust the doctor’s recommendation whether CT scan is indicated.”

The Yale study was supported with a grant from the Agency for Healthcare Research and Quality.

Source: Yale School of Medicine
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Melnick ER et al. (2015) Understanding Overuse of ComputedTomography for Minor Head Injury in the Emergency Department: ATriangulated Qualitative Study. Academic Emergency Medicine; published online 14 November 2015. DOI: 10.1111/acem.12824

Published on : Mon, 23 Nov 2015

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healthmanagement, emergency department, computed tomography, CT scans, head injury, patient-physician relationship New research from Yale University has found that amongst other factors, strengthening the doctor-patient relationship can help to reduce CT scan overuse in minor head injury. The findings are reported in the journal Academic Emergency Medicine.

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