A survey of nearly 500 emergency physicians found that 97 percent have personally ordered diagnostic tests that they knew were medically unnecessary.
The most common reasons they ordered unnecessary tests were:
– Fear of litigation
– To avoid missing a low-probability diagnosis
Unnecessary testing is costly and can lead to negative consequences for patients, such as false positives and unneeded radiation exposure. Healthcare executives should foster cardiovascular imaging best practices among staff to reduce unnecessary testing and patient risks. Promoting the utilization of appropriateness criteria, working toward interoperability and promoting patient awareness will help organizations follow best practices.
Work Toward Interoperability
Healthcare executives can reduce redundant and unnecessary testing by working toward interoperability. Having access to patients’ transparent, longitudinal medical records allows physicians to better make decisions about what tests to order.
“Without historical information, clinicians may order or perform redundant exams … or other procedures that could be avoided,” says David Mendelson, M.D, professor of radiology and co-chair of Integrating the Healthcare Enterprise (IHE) International. “Interoperability would support organizational efforts to avoid the duplication of costly services and also help ensure quality decision making.”
For example, an emergency room physician seeing a patient with shortness of breath and a racing heart can access the patient’s longitudinal health record. She is able to review the patient’s history of panic attacks and evaluate a recent ECG of panic-related atrial fibrillation. The physician may determine that her patient should be treated for a panic attack rather than undergo an echocardiography.
Increase Patient Awareness of Risks Associated with Radiation Exposure
To reduce health risks associated with unnecessary imaging, healthcare leaders can also develop processes for staff to educate patients about best practices. For patients, knowing the risks associated with radiation exposure is a crucial component to reducing unnecessary exposure from medical imaging, according to the FDA. In the FDA’s whitepaper about radiation safety, providers are encouraged to educate patients about the risks of radiation exposure.
A patient medical imaging record card is available for patients to track their medical imaging history and share that information with physicians. It includes questions for patients to ask, such as about alternative exams or tests that do not use radiation, and also suggests that patients not insist on a certain exam if their physician has explained it’s unnecessary.
Utilize Appropriateness Criteria
Finally, healthcare leaders can foster best practices in cardiovascular imaging by ensuring their clinicians have access to appropriateness criteria. Appropriateness criteria help practitioners follow evidence-based guidelines and are particularly valuable when incorporated into cardiovascular information system solutions. Solutions are available that pull data collected from past reports into a clinical decision support system (CDS). The CDS drives appropriateness and helps start a dialogue between imaging specialists and referring physicians about evidence-based analytics.
To reduce risks and unnecessary costs associated with unnecessary testing in cardiovascular imaging, healthcare leaders should foster best practices by working toward interoperability, increasing patient awareness, and utilizing appropriateness criteria. Investing in patient education and the medical imaging technology available can ultimately help health systems push down costs as a whole and empower physicians to not order diagnostic tests they know are unnecessary.
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