Ordering Unnecessary Imaging Tests “May Be A Systemic Problem”

Not all of the advanced imaging studies emergency medicine physicians ordered were medically necessary, according to a recent study.

“As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions,” said the study’s authors.
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“The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]),” they said.

For the study, researchers administered the survey to 478 EPs; 91% of those approached completed the survey, 68% of them were board-certified, and nearly 50% worked in academic emergency departments (EDs).

The surveys revealed that over 85% of EP’s who completed the survey said that too many diagnostic tests are ordered in their emergency departments and 97% of the survey respondents reported that at least some of the advanced imaging studies they have personally ordered were medically unnecessary.

According to researchers, the main reasons for over-imaging were fears of litigation and missing a low-probability diagnosis in patients.

The researchers listed helpful solutions for limiting unnecessary imaging, which included increased patient involvement through education, shared decision-making, improved education of physicians on diagnostic testing, and feedback to physicians on test-ordering metrics.

The complete study was published in the March issue of Academic Emergency Medicine.

-Michelle Canales Butcher

Reference:

Kanzaria HK, Hoffman JR, Probst MD, et al. Emergency physicians perceptions of medically unnecessary advanced diagnostic imaging. AEM. 2015 March [epub ahead of print] doi: 10.1111/acem.12625.