CDS helps trauma center reduce unnecessary imaging for ED patients with renal colic

Implementing locally developed appropriate use criteria (AUC) as clinical decision support (CDS) could help reduce unnecessary imaging for emergency department (ED) patients with renal colic, according to new research published in the American Journal of Roentgenology.

AUC for patients younger than 50 years old with a history of uncomplicated nephrolithiasis who present at the ED with renal colic was developed by a team of four attending physicians. The age was limited to 50 to decrease the chances of abdominal aortic aneurysm in patients, and a history of uncomplicated nephrolithiasis was used to decrease the chances of the patient needing imaging. Feedback from the trauma center’s emergency medicine, emergency radiology and urology departments was used to build the final AUC, which was then embedded in the center’s CDS. When a CT request was entered and the AUC detected an alternate recommendation, the person placing the order would receive an alert. Adherence was optional.  

Data from 18 months before implementation and 18 months after implementation was evaluated at both the trauma center in question and a comparable hospital, which served as the control site. Overall, the study included 467 patients from before AUC implementation and 306 patients after AUC implementation. At the study site, the CT of ureter rate decreased from 23.7 percent before implementation to 14.8 percent after. At the control site, the rate was unchanged, suggesting that the AUC made a significant impact.

“The implementation of a multidisciplinary CDS-enabled AUC based on local best practice was associated with a significant decrease in the use of CT for ED patients with renal colic and a history of uncomplicated nephrolithiasis,” wrote lead author Ali S. Raja, MD, department of radiology at Brigham and Women’s Hospital in Boston, and colleagues.

The authors added testing the validity of their AUC was crucial because “unnecessary and intrusive CDS” is an issue for healthcare providers and can frustrate ordering physicians, even leading to burnout, the authors wrote.

“Regardless of our interdisciplinary team's expert opinion, if the AUC had proven ineffective, we would have iterated or suppressed the CDS alerts to reduce unnecessary interruptions for ordering providers during the order-entry process,” they wrote.