Basham, Hilary F., DO

Dewar, Kate M., DO

Greenberg, Marna R, DO, MPH

Rupp, Valerie A., RN, BSN

Weigner, Michael B., MD

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Emergency Medicine Impact of Education on Physician Attitudes Toward Computed Tomography (CT) Utilization and Consent Michael B. Weigner MD Lehigh Valley Health Network, Michael_B.Weigner@lvhn.org Kate M. Dewar DO Lehigh Valley Health Network Hilary F. Basham DO Lehigh Valley Health Network Valerie A. Rupp RN, BSN Lehigh Valley Health Network, Valerie.Rupp@lvhn.org Marna R. Greenberg DO, MPH Lehigh Valley Health Network, marna.greenberg@lvhn.org Follow this and additional works at: https://scholarlyworks.lvhn.org/emergency-medicine  Part of the Emergency Medicine Commons Published In/Presented At Weigner, M., Dewar, K., Basham, H., Rupp, V., & Greenberg, M. (2010, September 28). Impact of Education on Physician Attitudes Toward CT utilization and Consent. Poster presented at: ACEP Research Forum, Las Vegas, NV. Weigner, M., Dewar, K., Basham, H., Rupp, V., & Greenberg, M. (2010, September 28). Impact of Education on Physician Attitudes Toward CT utilization and Consent. Poster presented at: PA ACP, Harrisburg, PA. (April 12, 2011) This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Lehigh Valley Health Network, Allentown, PennsylvaniaWith increasing focus on the risks of radiation exposure from CT scans, we set out to determine whether emergency physician attitudes and their predictions of ordering behaviors could be influenced by education. Impact of Education on Physician Attitudes toward Computed Tomography (CT) Utilization and Consent Michael Weigner, MD; Kate Dewar, DO; Hilary Basham, DO; Valerie Rupp, RN, BSN; Marna Rayl Greenberg, DO, MPHObjective: Results:A total of 75 physicians participated in the study; 69% (52/75) were residents and 31% (23/75) were attendings. Of those surveyed, 34% were females and 66% were male; 95% were white, and 99% non-Hispanic. Ordering a CT in which an adverse event occurred was reported by 43% (32/75) of respondents. Some (13%;10/75) reported they did not know if informed consent was required for CT scans ordered from their Emergency Department. Pre education, 89% (67/75) reported sometimes ordering a CT due to a consultant request that they did not think was indicated and 92% (69/75) reported that they sometimes ordered a CT to appease a patient or family. 85% (64/75) reported that they sometimes ordered a CT scan defensively due to malpractice risk. After the education session, physicians were more likely to believe a patient should give informed consent prior to CT (p=0.047; 52/74 before, 63/74 after) and predicted that they would be more likely to verbally discuss the risks/benefits of CT with their patients all of the time (p=0.002; 4/75 before, 18/75 after). Compared to their estimated current ordering patterns, education did not significantly influence their predictions of sometimes ordering ‘defensive’ CTs due to malpractice risk (p>0.999; 64/75 before, 65/75 after). Table 2.Percent Change in Physician CT Scan Reported Prediction of Behavior Following Brief Educational Intervention Regarding Informed ConsentWe surveyed emergency medicine resident and attending physicians at a tertiary suburban, level I trauma center with a yearly census of 74,000. The emergency medicine dually accredited residency has 56 residents in a 4-year program. IRB approval was obtained after expedited review. Education was mandatory for those in attendance at the grand rounds and department meeting where presentations occurred. However, participation in the research survey was voluntary and anonymous for all participants. Physicians were given a baseline survey that encompassed personal demographics, attitudes toward consent, knowledge of patient adverse reactions,and ordering behaviors. Thereafter, a brief power point presentation was given regarding CT scan risks. Subsequently, each participant received a matched follow up survey which was completed and returned in a sealed envelope with their baseline survey to a restricted access collection box. The survey format included yes/no and multiple-choice questions. Specifically, physicians estimated the number of scans they ordered per shift, the type of scan they most frequently ordered, the risk factors they considered prior to ordering a CT, and the influences that impacted the studies they ordered. Data analysis was performed using simple frequencies and Pearson’s chi square. Methods:Conclusions:After a brief education session about the risks of CT utilization, physicians are significantly more likely to believe that patients should give informed consent prior to CT scan. Additionally, education influenced physician predictions that they would be significantly more likely to verbally discuss the risks and benefits of CT with their patients all the time. However, education does not appear to significantly influence physician predictions of sometimes ordering a ‘defensive’ CT scan due to malpractice risk.Table 1.Demographic Characteristics PercentLevel of TrainingPGY1 19PGY2 19PGY3 16PGY4 16Attending 31Age20-29 yrs 2530-39 yrs 5940-49 yrs 850-59 yrs 660+ yrs 1GenderFemale 35Male 65What Type of CT Scan do you Order Most Frequently?Head 70Abdomen/Pelvis (contrast) 23Abdomen/Pelvis (no contrast) 7For What Chief Complaint do you Order CT Scans the Most?Trauma 57Abdominal pain 39Other 4Is Informed Consent Required for CT SCans Ordered form the Emergency Department?Yes 11No 76Don’t know 13Options PercentPre EducationPercentPost EducationHow often do you verbally discuss with the patient (or their representative) the risks or benefits of having a CT done?Never 1 1Sometimes 44 23Most of the time 49 51All of the time 5 24How often to you consider the patients renal function when ordering a CT scan?Never 0 0Sometimes 10 12Most of the time 41 38All of the time 48 50How often do you consider the patients age when ordering a CT scan?Never 1 1Sometimes 18 15Most of the time 30 39All of the time 51 45How often to you consider how many previous CT scans a patient has had prior to ordering a CT scan?Never 1 4Sometimes 37 31Most of the time 47 43All of the time 15 23

Impact of Education on Physician Attitudes Toward Computed Tomography (CT) Utilization and Consent

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