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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Serial In-Person Feedback | Experimental | Providers are given recurring individualized in-person feedback on their practice patterns. |
|
| In-Person Feedback with Serial Electronic Feedback | Experimental | Providers are given one-time individualized in-person feedback on their practice patterns, followed by recurrent individualized electronic feedback. |
|
| Control | No Intervention | Providers are not given any feedback on their practice patterns. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Audit and Feedback on Individual Practice Patterns | Behavioral | Providers are given feedback on their practice patterns of ordering computed tomography of the cervical spine. |
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| Measure | Description | Time Frame |
|---|---|---|
| Percent NEXUS-Negative | Percentage of CT C-spine studies that an individual provider ordered on NEXUS-negative patients | 6 months |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Karl T Chamberlin, MD | University of Massachusetts, Worcester | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Massachusetts Chan Medical School | Worcester | Massachusetts | 01655 | United States |
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| ID | Term |
|---|---|
| D004630 | Emergencies |
| D014947 | Wounds and Injuries |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| 6 months |
| Number of CTs | Number of CT scans of the cervical spine ordered by each provider | 6 months |