Radiology care means ensuring optimal use of imaging for diagnosis and treatment of diseases. Needless to say, radiologists play an important role in helping referring physicians avoid ordering imaging tests that provide not much diagnostic value – and unnecessarily expose patients to radiation.
That's certainly the main reason behind the American College of Radiology's ongoing initiative R-SCAN, short for Radiology Support, Communication and Alignment Network. Through this programme, radiologists are able to help with educating physicians from different specialities, as well as patients, about better imaging utilisation.
For example, R-SCAN runs a website where ordering physicians can access a host of online tools that will support them in making clinical decisions, thereby reducing unnecessary imaging exams and bringing care cost down. Also, the group has produced education materials designed to make patients become more aware as to why certain imaging tests would not yield much of value.
R-SCAN's campaign for better imaging use is closely aligned with Choosing Wisely recommendations, such as not ordering imaging for uncomplicated headaches and not ordering an examination for suspected pulmonary embolism without a moderate or high pretest probability for pulmonary embolism.
One of the ways the network monitors the effectiveness of their campaign is by looking at research data.
Based on a study of 70 radiology practices that took part in the programme, it was found that the ordering of high-yield imaging improved by nearly 22% after the R-SCAN intervention. In this study, some 9,000 cases were reviewed by researchers – including 4,950 baseline cases and 4,060 cases after an educational intervention was implemented.
As of December 2018, according to the network, they had supported 189 projects, engaged 120 radiology practices and recruited more than 10,000 clinicians.
Bayhealth, the largest health system in the central and southern part of Delaware, is among those institutions that have imbibed R-SCAN ideas and practices. The health system has been successful in improving the number of high-yield images ordered by emergency physicians.
Bayhealth's quality improvement initiative was spearheaded by radiologist Thomas E. Vaughan, MD, and emergency physician Craig D. Hochstein, MD.
Drs. Vaughan and Hochstein suggest these steps when implementing an R-SCAN intervention:
- Form a group of people who work well together, including a radiologist, a physician from the speciality you are working with and an administrative person to be part of the leadership of the project.
- Make sure physicians have the tools they need to make decisions and give them evidence-based support (through education sessions and emails) of why an image may produce low-yield results in certain situations. Also create posters describing when imaging is needed and when it’s not that can be hung for physicians and patients to see.
- Give physicians “permission to not order the test. Many felt like they were obliged to order tests, especially tests that the patient wanted,” Dr Hochstein said.
- Take the time and effort to monitor results, and share the results with everyone so they can see the progress.
- Reach out to physicians found to be responsible for a larger percentage of the low-yield images ordered and provide reinforcement materials on high-yield image ordering.
Source: American Medical Association