A double-check before ordering CAT scans

Several years ago, experts sounded alarms about the overuse of CAT scans and the added risk of radiation exposure for patients.

Two Philadelphia hospitals are testing a tool that forces doctors to slow down and reconsider whether the test is truly needed. Dr. Angela Mills designed a series of questions to query emergency room doctors caring for patients with abdominal pain.

The tool doesn’t stop doctors from ordering a CAT scan, but Mills says they do have to answer the questions.

“It’s just a stopgap to make the physicians stop and think about what they are ordering,” Mills said. “After the first week, if you’ve ordered a couple, or tried to order a couple CAT scans, and you’ve had to fill out the four questions, I think that learning carries on.”

A CAT scan is a type of imaging test that produces a three-dimensional picture and uses more radiation than a traditional X-ray.

Mills says abdominal pain can be difficult to diagnose and a CAT scan can be very accurate. So, for some doctors, it’s become a go-to test.

Research suggests that a full one-third of CAT scans prescribed in the United States are unnecessary.

Mills’ team tested the tool at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center. She designed the tool for patient safety, but it could also save money.

“We certainly do look at it throughout. And if patients are undergoing unnecessary tests it leads to crowding in the emergency department, which then leads to delays in the patients in our waiting rooms,” Mills said. “It’s a cost in that sense, in that sick patients aren’t able to be evaluated quickly.”

When the tool was used, patients were 10 percent less likely to undergo a CAT scan.

Mills is now testing an advanced version of her tool. It shows a graph of how much radiation a patient has had in recent years and provides an easy link to other imaging tests performed within the health system.