In September 2016, the American College of Radiology (ACR) introduced its Radiology Support, Communication and Alignment Network (R-SCAN), a platform through which clinicians and radiologists can collaborate on projects to improve imaging appropriateness based on Choosing Wisely recommendations. R-SCAN is supported by a Transforming Clinical Practice Initiative grant.
Alexandre R. Frigini, MD, a radiologist at Baylor Medical College, was one of the first physicians to complete an improvement project through R-SCAN. He presented findings to colleagues during “ACR 2016 —The Crossroads of Radiology®.”
Dr. Frigini and his team focused on the American College of Chest Physicians and American Thoracic Society’s recommendation which states, “Don’t perform chest computed tomography (CT angiography) to evaluate for possible pulmonary embolism (PE) in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay.”
“You want to choose a topic that is most impactful to your practice,” Dr. Frigini said. “We knew that we were performing too many CT scans for PE protocol and R-SCAN gave us the mechanism to coordinate across departments to promote evidence-based care.”
Dr. Frigini identified Baylor emergency physicians as collaborators on the project since they routinely order CT scans for PE clinical indication. The chief of emergency was very receptive to the idea of collaborating to reduce avoidable imaging.
The next steps included registering the project in R-SCAN and selecting 100 previous cases to enter into the R-SCAN database. As part of this process, the Baylor radiology team working on the project rated each case using the ACR Select clinical decision support tool to determine if it was warranted or not. Baseline results showed that 75 of the retrospectively ordered tests were warranted and 25 were not.
From there, the team moved into the clinician education phase of the project and opted to do an emergency medicine grand rounds that included a review of Choosing Wisely and emergency medicine guidelines for ordering. The chief of emergency medicine then sent emails to clinicians as a follow-up.
Shortly after the educational intervention, the team identified 100 cases (CT scans for PE protocol) over nearly seven weeks and, again using the ACR Select tool, rated them for appropriateness and entered case data into the R-SCAN database. Comparing their baseline to post education results, the team had reduced inappropriate orders by half – finding 12 tests unwarranted.
As the final phase of the project, R-SCAN generates a report which is sent to the American Board of Radiology so physicians can receive maintenance of certification (MOC) credit for their quality improvement project. Since most collaborating physicians are certified by other medical boards, ACR is also working to ensure they get similar recognition.
Dr. Frigini said the report is useful because he could share it with colleagues, hospital leadership, insurers and other physicians as a success story. It can also be used to determine if the project is sustainable.
“We want to revisit the data and see if physicians are sticking with the recommendations or if they go back to old ordering patterns,” he said. “That could be a new project.”