EMR Tool Cuts CT Scans in Emergency Room Patients

Electronic medical records (EMRs) can keep track of radiation exposure and reduce unnecessary CT scans in emergency room patients with abdominal pain, said researchers from the Perelman School of Medicine at the University of Pennsylvania.

Emergency room physicians often rely on CT scans to determine the cause of abdominal pain, but there are few clear guidelines on which patients should receive such scans. With a 10-fold increase in CT use since the mid-90s, there is concern with its increased use, researchers said. Their study was presented at the annual meeting for the Society for Academic Emergency Medicine this week.

Using the records of 11,176 patients, the researchers assessed the effectiveness of a new tool that was embedded in patients’ EMRs. The tool presents physicians with a series of questions to consider before they could order a CT scan for patients with abdominal pain. Questions examined what the physicians are looking for and how likely they thought the patient actually had that problem. In addition, if the CT was ordered by a resident, the attending physician would have to approve it before the CT could be performed.

The researchers found that prior to implementation of the program with the “accountability tool,” 32.3 percent of the patients presenting to the ER with abdominal pain underwent CT scans. After the tool was implemented, the rate dropped to 28 percent. After adjusting for confounding factors, the researchers determined that the patients were 10 percent less likely to have a CT scan when this tool was used.

“For many patients, like those who are older or have cancer, this tool might not make a difference,” said Angela M. Mills, MD, an assistant professor of Emergency Medicine and medical director of the emergency department at the Hospital of the University of Pennsylvania. “But there are many abdominal patients who are younger, healthier, and who have things that are usually not life-threatening like kidney stones, for whom we are hoping this will reduce their exposure to unnecessary radiation.”