Reducing unecessary Tests

by Dr Nick
NPR featured a segment recently on the reducing unnecessary scans “Requiring Doctors To Justify Scans Reduces Waste” with a simple 9 point scale to demonstrate the value of a test in the diagnostic process. Low score means the test has limited or no value and high score means the test has a high chance of providing additional information to the diagnostic support process

For instance, ordering an MRI for uncomplicated, acute low-back pain could get a “2,” or not such a hot idea, according to similar criteria developed by the American College of Radiology. But if the patient in pain had previously undergone back surgery, then the scan might get an “8,” a score strongly in favor of an MRI.

Not only did the introduction of this assessment help in reducing the number of tests – a decrease from 5.4 to 1.9% of scans of the total number of scans but there was an overall improvement in the number of scans being ordered by physicians vs booked by support staff.
From a patient safety and quality of care long term studies have not been carried out but given the increasing focus seen on excessive radiation exposure linked to increased use of imaging – in particular CT scanning that include over dosage: “Two more hospitals report CT scan radiation overdoses” as well as [excess usage especially in childrenParents Can Help Limit Kids’ Exposure to Medical Imaging“)
All round – good progress in applying technology to help improve quality, reduce iatrogenic effects. Perhaps we might see this technology offered to patients to help them assess with their doctors the value of a test 

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