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Effect of a preauthorization policy on the utilization rate of after-hours emergency department neuroradiology computed tomography

Published online by Cambridge University Press:  04 March 2015

Deljit Dhanoa ,
Kirsteen Rennie Burton ,
Lyne Noël de Tilly  and
Ravi J. Menezes
Deljit Dhanoa*
Affiliation:
Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON
Kirsteen Rennie Burton
Affiliation:
Department of Medical Imaging, University of Toronto, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
Lyne Noël de Tilly
Affiliation:
Department of Radiology, St. Michael's Hospital, University of Toronto, Toronto, ON
Ravi J. Menezes
Affiliation:
Department of Medical Imaging, University Health Network, Toronto, ON
*
13 Seton Park Road, Toronto, ON M3C 3Z7; [email protected]

Abstract

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Objective:

To evaluate the impact of an emergency department (ED) automatic preauthorization policy on after-hours utilization of neuroradiology computed tomography (CT).

Methods:

All CT studies of the head with contrast facial bones, orbits, spine, and neck requested through the ED and performed between January 1, 2004, and December 31, 2010, were reviewed. The preauthorization policy was instituted on February 25, 2008. A control group of noncontrast CT head studies was used for comparison. Pre- and postpolicy implementation utilization rates were compared between the control group of noncontrast CT head studies and the study group neuroradiology CT studies.

Results:

During the study period, 408,501 ED patient visits occurred and 20,703 neuroradiology CT studies were carried out. The pre- and postimplementation groups of noncontrast CT head scans totalled 7,474 and 6,094, respectively, whereas the pre- and postimplementation groups of all other neuroradiology CT studies totalled 3,833 and 3,302, respectively. The CT utilization between the two groups did not differ significantly: the noncontrast head group pre- and postpolicy implementation increased by 0.31 to 3.41%, whereas the utilization of all other neuroradiology CT studies increased by 0.22 to 1.84% (p value = 0.061 for a difference between groups).

Conclusion:

Implementation of an automatic preauthorization policy for after-hours neuroradiology CT studies did not result in a statistically significant increase in CT utilization. This suggests that concerns regarding the negative effects of such policiesmay be unfounded, and further research in this area is warranted.

Keywords

computed tomographyemergency medicineneuroradiologyradiologyutilizationutilization rate
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 3 , May 2013 , pp. 161 - 166
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

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