Improving CT cervical spine imaging in the Emergency Department

Quality Improvement Poster Download

Background & Problem

Only 30% of CT c-spines are performed within 1 hour of recognition of risk factor in Gloucestershire Hospitals Emergency Departments. NICE guidelines state ALL CT c-spines should take place within 1 hour of a key risk being identified. Around 0.5% of the average 2500 patients seen in Gloucestershire Emergency Departments seen each week receive a CT scan of their cervical spine.

Aim

To increase percentage of CT scans of c-spine within 1 hour of clinician assign time to 50% by the end of April 2017 without creating additional paperwork or requiring additional funding.

Method

• Audit of all patients receiving CT c-spine in Cheltenham General And Gloucestershire Royal emergency departments from November 2016 to May 2017
• Quality standard was set at CT scan being performed within 1 hour of “clinician assign time”
• The interventions used existing A&E resources and processes: lunchtime teaching (2 sessions, 1 junior doctor led and one consultant led), 1-1 consultant led tutorials and a poster campaign when the intervention was “theme of the fortnight”.

Results

The interventions significantly increased the number and proportion of patients receiving appropriate imaging, and increased the number of patients receiving their CT scan within 1 hour of assessment. This improvement was made without any additional financial input, no increase in inappropriate imaging, and without generating unnecessary documentation. The percentage of CT c-spines performed within 1 hour did not significantly change (30% pre-intervention to 38% post intervention).

Implications

Existing departmental education resources and processes such as “theme of the fortnight”, consultant “shop-floor” teaching and lunchtime teaching are robust methods of enacting change. Future improvements should focus on consolidation of this process, and alternative improvements such as improved triage to reduce time to CT booking in appropriate patients