Reducing demand for computed tomography
Editor – I was interested in the article by Lewis et al in July on a nudge intervention aimed at reducing demand for computed tomography (CT).1 While impressed with the reduction in CT requests, I was surprised by their decision to place the intervention (a message highlighting the radiation risk from the scan) in the report of scans, rather than earlier in the process of ordering a scan. In their discussion they state that ‘This approach was preferred to the alternative of delivering the information at the time of deciding to do the scan when it could impact on the efficient delivery of clinical care’. Their subsequent argument that it is difficult to go back to a patient and explain why CT may not be necessary is not entirely convincing.
As most radiology tests in the UK are now ordered electronically, computer physician order entry (CPOE) systems have the ability to display messages during the process of ordering a test. There is also the potential for CPOE systems to calculate individual risk (and display different messages) depending for example on the age of the patient or the number of previous CT they have undergone. It would be interesting to know whether such a system might have an even greater impact in reducing CT ordered, and particularly in younger patients who are at greater risk of cancer from ionising radiation.
- © 2019 Royal College of Physicians
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- Lewis S
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