Hospitals are making giant strides in reducing "never events" like health care-acquired infections, wrong-site surgeries and patient falls. Now, another big area of concern is emerging — exposing patients to too much radiation during imaging tests. So far it hasn't gained a prominent spot on many hospital leaders' must-do lists, but that is about to change.
Radiation dose management is "a bit more challenging to grasp" for hospital leaders, according to Jeff Hersh, M.D., chief medical officer for GE Healthcare. "It's easy to demonstrate cause and effect for health care-acquired infections and patient falls, for example. It's more difficult to link radiation dosage with the potential risk."
However, "for a CEO of an organization that either is or will be entering into an accountable care contract, clinical decision support for high-end imaging utilization management has to be a key tactic because it gets to the triple aim of better safety, better cost and better population health management," asserts Rishi Sikka, M.D., vice president of clinical transformation at Advocate Health Care in Oak Park, Ill., "As organizations move toward accountable care and as the payment models change into shared savings models, we will see this bubble up."
Hersh and Sikka participated in a roundtable of radiology experts convened by Hospitals & Health Networks in Chicago in August. Panelists discussed the need for hospitals to establish radiation dose management programs that ensure patients undergo the right imaging procedures for their individual needs — and, in so doing, receive the maximum benefit at the minimum risk.
The discussion was part of H&HN's Executive Dialogue series. Seven participants from around the country described the benefits of breakthrough imaging technologies, which produce increasingly precise pictures, but at an ever-higher radiation dose. They talked about the role of radiologists in leading the clinical effort to ensure that the correct tests are ordered using the most appropriate technology. And they stressed the need for hospital management to take on the cultural end, which includes setting organizational priorities, bringing other members of the medical staff on board, making sure appropriate data is collected and analyzed and, finally, enforcing staff compliance.
The main motivation for hospitals to set up dose management protocols is twofold: improve quality of care and cut unnecessary expenses.
"We have to focus on the patient safety component," said William Shuman, M.D., vice chairman, radiology, at the University of Washington Medical Center in Seattle. "The risk is real. We are morally obligated to drive out all the risk that we can from the system, and this is a manageable risk."
At the same time, there are fiscal benefits. "Appropriate utilization impacts length of stay and length of stay is one of the biggest variables in inpatient cost now," Shuman said. "But it impacts outpatient expenses as well, which, of course, we'll all be paying for in a centralized way in the future."
"Hospital leaders need to acknowledge and empower people who have the expertise and are willing to do this," said Keith Hentel, M.D., chief of the emergency and musculoskeletal radiology division at New York-Presbyterian Hospital–Weill Cornell Medical Center in New York City. "Dose management programs do not require a significant financial investment; they do require the investment of enthusiastic people dedicated to lowering radiation exposure. That's one of the roles of leadership — finding dedicated, enthusiastic people to lead the program and providing them with the time and resources they need to get it done."
Added Ella Kazerooni, M.D., director of the cardiothoracic radiology division at the University of Michigan Health System, "Radiation dose management is probably the single most important public health contribution that radiology can make in terms of quality and safety."
I encourage you to read the entire Executive Dialogue, which was sponsored by GE Healthcare and the GE Blueprint for Low Dose program.