CT C-spine Audit and Feedback

Study Overview
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Brief Summary
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This is a prospective quality improvement study to assess the effect of using an audit-and-feedback process for emergency providers on utilization of computed tomography of the cervical spine. The objective of this study is to determine whether providing repeated individualized feedback on CT C-spine utilization to emergency providers alters their practice pattern and reduces overutilization. The investigators hypothesize that emergency providers who receive individualized feedback regarding their CT C-spine utilization on a regular basis will alter their practice pattern to reduce overutilization of this imaging study.

Official Title
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Audit and Feedback for Computed Tomography of the Cervical Spine in the Emergency Department

Conditions
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Cervical Spine Injury, Emergencies, Trauma

Intervention / Treatment
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* Behavioral: Audit and Feedback on Individual Practice Patterns


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Emergency medicine physician, nurse practitioner, or physician assistant Ordered at least 5 CT scans of the cervical spine on adult patients in the two-month pre-intervention period Exclusion Criteria: Non-emergency providers Ordered few than 5 studies in the pre-intervention period
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Serial In-Person Feedback<br>Providers are given recurring individualized in-person feedback on their practice patterns. | Behavioral: Audit and Feedback on Individual Practice Patterns<br>* Providers are given feedback on their practice patterns of ordering computed tomography of the cervical spine.<br>|
| Experimental: In-Person Feedback with Serial Electronic Feedback<br>Providers are given one-time individualized in-person feedback on their practice patterns, followed by recurrent individualized electronic feedback. | Behavioral: Audit and Feedback on Individual Practice Patterns<br>* Providers are given feedback on their practice patterns of ordering computed tomography of the cervical spine.<br>|
| No Intervention: Control<br>Providers are not given any feedback on their practice patterns. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent NEXUS-Negative | Percentage of CT C-spine studies that an individual provider ordered on NEXUS-negative patients | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Fractures | Number of cervical spine fractures identified on CT for patients who are NEXUS-negative | 6 months | 
| Clinically Significant Fractures | Number of cervical spine fractures identified on CT for patients who are NEXUS-negative that required procedural intervention, hospitalization, or prolonged immobilization | 6 months | 
| Number of CTs | Number of CT scans of the cervical spine ordered by each provider | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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NEXUS, computed tomography, resource utilization, emergency medicine