Adoption of a "scan-and-go" policy for elective CT studies resulted in a 43% increase in study volume and elimination of a patient backlog, with no adverse effect on patient care, a Boston radiologist reported at an RSNA scientific session.

The primary effect of the policy was to reduce the average CT study time by more than a third, leaving more time for additional studies during a typical work day.

"Adoption of a scan-and-go policy improved scanner utilization by increasing patient throughput," said Dr. Kevin Reynolds, a radiologist at Beth Israel Deaconess Medical Center. "After adoption of the policy, we reduced both fixed and variable costs per CT scan. These benefits were achieved without any obvious adverse effect on patient care."

The decision to evaluate a scan-and-go strategy for non-urgent CT studies arose from a 10-day scheduling backlog that had developed with a policy of radiologist-monitoring of every CT study.

"This was unsatisfactory to our physicians and could lead to a potential loss of referrals," Reynolds said.

In October 1998, the medical center implemented a scan-and-go policy for all non-urgent CT studies. The radiology department had more than 30 body CT protocols at the time, and a radiologist selected a protocol in advance of each study on the basis of clinical indications. The protocols provided specified parameters such as injection volume, contrast, injection rate, scan delay, and filming.

CT technologists performed a preliminary review of each exam at the scanner. The technologists were instructed to perform four monitoring checks of the studies: adequacy of bowel opacification with oral preparation, adequacy of intravenous contrast bolus, need for thin or delayed images, and the presence of abnormal findings that would require immediate attention of the radiology staff.

Attending radiologists, with assistance from residents and fellows, performed a complete review of CT studies twice daily. If a study was deemed inadequate, the patient was asked to return at his or her convenience for a follow-up study, which was performed free of charge to the patient.

Reynolds and colleagues compared CT utilization for six-month periods before and after implementation of the scan-and-go policy. They found that the average study time declined from 19.5 minutes before the policy to 12.5 minutes afterward. The seven-minute decrease in exam time permitted a 43% increase in study volume: 4089 exams in the six months after the protocol, versus 2853 exams in the six-month period before it.

"We accommodated this increase in volume without additional CT technologists or scanners," Reynolds said. "The decrease in exam time helped us virtually eliminate our scheduling backlog. We now perform CT studies within 24 hours of request."

During the initial six-month evaluation of the scan-and-go policy, five patients had to return for repeat exams. The reasons were non-opacification of the bowel (two cases), noncontrast enhancement of the liver, need for thin sections of the pancreas, and need for rectal contrast.