Reducing unnecessary scans

One of the hallmarks of growing up is becoming more active and mobile. But for many kids, increased activity and mobility also bring increased risk for injury. Accidents can happen when least expected and during activities as mundane as traveling in a car or playing team sports.

For Jeff Louie, M.D., a member of the U’s pediatric emergency medicine faculty and beneficiary of Masonic support, it is how we diagnose and assess these injuries that makes all the difference.

More harmful than helpful?

Louie is concerned with how often doctors use a powerful imaging tool—called a CT (computed tomography) scan—to determine the severity of neck injuries in children.

Although CT scans can take detailed pictures inside the body, they provide little benefit in the management of neck injuries and emit high levels of radiation that increase a child’s risk for developing brain or thyroid cancer.

“It’s believed that one in 10,000 children exposed to a head CT will develop a brain tumor,” says Louie. “Additionally, one in every 1,200 children under the age of 20 is affected by thyroid cancer each year. A child’s thyroid gland, which is found in the neck, is highly sensitive to radiation and mutating into cancer tissue.”

Providing the tools for change

Because CT scans may be more harmful than helpful, Louie believes it is critical to promote a less aggressive approach to diagnosing neck injuries in young people.

That’s why with Masonic support, he and his team are working with four emergency medicine departments in the Twin Cities to reduce the rate of pediatric CT scans.

Their tactics include everything from leading face-to-face presentations and meetings with medical staff to introducing new MRI guidelines and infographics about best practices.

They are especially enthusiastic about implementing a new best practice alert, which appears on the computer screen whenever a provider orders a neck CT scan. The alert explains that CT scanning in stable children is unlikely to detect injury and provides guidelines for appropriately handling neck injuries.

Louie and his colleagues are encouraged by the early results of their work. One of the emergency departments has dramatically reduced its use of CT scans, while the other three departments have made modest reductions.

Spreading best practices

Still, Louie acknowledges that change can be difficult for many emergency department physicians.

The next step for his team will be to equip medical directors to play a more active role in reducing CT scans by changing workplace culture.

One intervention they are considering, for example, is to provide emergency department directors with a list of physicians who frequently order neck CT scans. Their hope is that the directors would use this as an opportunity to review each case and consider new best practices with each doctor.

“Leaders within each emergency department are more likely to change culture than outside experts providing didactic teaching,” Louie says.

Louie and his team also want to introduce tools that empower patients and providers to make health care decisions together. This includes a process called shared decision making, which balances patient values and preferences with the best clinical evidence available, as well as educational materials about neck injuries and radiation risks.

Positioned for success

Support from Minnesota Masonic Charities has played a key role in launching this research and positioning Louie’s team for future success.

After completing their work with local emergency departments, they hope to collaborate with the Minnesota Department of Health to reduce pediatric neck CT scans in hospitals across the state. Louie also believes that his team’s quality improvement tactics could help change the ways in which a variety of common childhood illnesses are treated.

“We have used this grant to hire an amazing research team. We also have developed ideas and made handouts and brochures that would never have otherwise been possible,” says Louie. “Having this funding has allowed us to be creative in ways we could never have imagined.”