Proposed Solution: Implementation and Evaluation, Capstone Project Example

Introduction

This capstone project addresses overuse of radiation equipment (particularly computer tomography (CT) scans) in the diagnosis of patients. The literature provides two main solutions at the hospital level to ameliorate this problem: 1) Education of patients and doctors; 2) Use of alternative machines in diagnosis.  This paper also addresses numerous interventions and evaluations to assess whether a hospital has adequately addressed the problem.

Solutions

The first solution focuses on educating patients regarding the risks associated with CT scans including the connection between excessive radiation and increased risks for cancer.  Education initiatives at the patient level should focus on giving adults undergoing CT scans information regarding the level of radiation and risks associated with the scan for diagnostic purposes; although CT scans are also used extensively in emergency care, the opportunity for education in those circumstances is limited.  Doctors in all departments, particularly radiology, will be targeted to understand risks associated with CT scan and the current level of CT scans ordered in each department.

The second main solution is to use alternative diagnostic methods (where possible) that do not require patient exposure to excessive radiation-this will also include examination of patient’s medical history to establish previous levels of radiation exposure. While there is inevitably an element of education in this solution, this part of solution focuses on hospital investment in alternative diagnostic equipment including MRI, ultrasound, or thermography technology.

Evaluation

In order to evaluate whether the solutions proposed have ameliorated the problem, there are several levels that need to be evaluated at the hospital level (Brenner & Hall, 2007).

At the macro level (entire hospital), there are a number of metrics to be evaluated.  First, the most important metric is the total number of CT scans performed in the hospitalcompared to historical levels of CT scans performed at the hospital and against benchmark hospitals of similar size located in the region. While this metric will provide a rough estimation whether the interventions have worked, as an absolute number, it will also need to be measured against patient volume to be calibrated correctly.

In addition to examining aggregate number of CT scans performed, administrators will also need to disaggregate department use of CT scans to identify which departments still exhibit a high level of use.  In accordance with the literature, special emphasis should be given to CT scans in the pediatric, emergency, and gerontology departments- hospital departments that traditionally order the most scans (Larson, D.B. et al., 2011).  The combination of aggregate and department data should give a more complete picture to understand the problem.  The resources to analyze these metrics should already be place; a tally of CT scan data should be available via insurance claims forms and patient data already stored on hospital computers.  At the department level, this initiative will need buy in from department heads to compile and analyze existing data.

In addition to collecting statistics, hospital administration will also need to authorize a systematic case study of patient CT scans (Smith-Bindman, Lipson & Marcus, 2009).  The systematic case study will involve randomly selecting patients that received CT scans over the past quarter in the hospital.  Once the random hospital files are selected, hospital administrators and the chief medical officer will need to go over each file to determine whether the CT scan was appropriate based on thepatient’s medical history and diagnosed medical condition.  Although this method is more qualitative in nature, it provides a “bottom-up” approach in addition to the “top-down” approach implemented via statistical methods.  Similar to the statistics exercise, the existing resources for this evaluation already exist in the hospital- it will merely be a reallocation exercise to produce and analyze the data.  The projected outcome of this deliverable is whether doctors appropriately ordered a CT scan in the case.

The third part of the evaluation is more complicated: the main question to be evaluated is whether the hospital has adequate investment in diagnostic equipment such as MRIs, ultrasound, or thermography technology (Brenner & Hall, 2007).

In order to evaluate whether this goal is met, hospital administrators should form a special sub-committee composed of administrators and doctors (e.g., radiation department) to assess the hospital’s needs and investment in this area.  The main outcome assessed is whether the hospital has acquired enough equipment and the use of that equipment.

The final assessment tool is the assessment of surveys given to patients who received a CT scan.  A random survey was given to patients who underwent CT scans checking whether they were given proper education regarding the risks associated with the procedure.  Department heads will be in charge of collection and analysis of the surveys; the outcome measured will be compliance with new regulations to educate all patients regarding the dangers associated with CT scans.

Conclusion

Although excess radiation exposure from CT scans is a key problem in today’s clinical environment, there are viable solutions to the problem: education initiatives, investment in alternate technologies, and supervision of compliance were suggested in this paper. While these solutions will take additional time from busy administrators and department heads, the reduced cost in monetary terms should be worth the investment.

References

Brenner, D & Hall, E. (2007).  Computed tomography- an increasing source of radiation exposure. New England Journal of Medicine. 357(22), 2277-2284.

Larson, D.B., Johnson, L.W., Schnell, B.M., Goske, M.J., Salisbury, S.R., Forman, H.P. (2011).  Rising use of CT in child visits to the emergency department in the United States 1995-2008. Radiology, 259(3), 793-801.

Smith-Bindman R, Lipson J, Marcus R. (2009). Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Archives of Internal Medicine. 169 (22), 2078–86.