Jeffrey P. Kanne, MD, professor, chief of thoracic imaging and radiology, and vice chair of quality and safety at University of Wisconsin, is the newest Choosing Wisely Champion recognized by the American College of Radiology (ACR) for his work in reducing unwarranted imaging.
Dr. Kanne says that for many years all patients in the intensive care unit (ICU) at the UW School of Medicine and Public Health were getting routine daily chest radiographs – despite evidence showing that on-demand imaging was just as effective in detecting clinically relevant abnormalities.
“It took nearly five years of discussing this issue with the critical care physicians to finally effect change. The key to success was not only including the medical director of the ICU but also nursing management and postgraduate trainees. With this initiative, we stopped performing routine daily chest radiographs in the medical ICU and only obtain them when the patient’s clinical condition warrants it,” he said.
In another project at UW, Dr. Kanne led efforts aimed at reducing chest radiographs for preoperative patients. He says about five to 10 used to be done each day – a number that has dropped to nearly zero.
“Reducing these inappropriate examinations was more challenging because each clinic and each surgical service used different preoperative checklists or order sets. The key was to reach out to physician and administrative leaders in quality in surgical services and first get their buy-in. They were able to work with nurses and physicians in a variety of clinics to change their preoperative testing,” he said. “While we still see a few inappropriate preoperative chest radiographs being performed, education of the ordering providers is often sufficient.”
Dr. Kanne has worked with radiology faculty to incorporate ACR Appropriateness Criteria – many of which he contributed to or authored – into UW’s Clinical Decision Support (CDS), which will be integrated into its electronic medical record system. He’s also led efforts to expand the availability of the CDS to include ambulatory care providers, and plans to include emergency department and inpatient units in the future.
Dr. Kanne also routinely leads information sessions to encourage his colleagues across the care team and throughout the UW health system to follow best practices.
“The biggest key to changing long-standing behaviors is to ensure that all stakeholders are at the table. Engage trainees, support staff, nursing, and physicians. Provide data and not just anecdotes. Clinical practice parameters and appropriateness criteria are a great place to start. Finally, be persistent and start small,” he said.