Prior to implementation, the average Head CT Utilization rate for Intermediate Risk Pediatric Head Injury patients was 21.1%. After the interventions, there was a 13.9% Head CT Utilization rate. In the last four months of the study period, a sustained rate of 9.3% was achieved, resulting in a 55.9% reduction. This case study evaluated the outcome of implementing Pediatric Minor Head Injury Computed Tomography (CT) Guidelines on Head CT utilization rates and the potential impact on the cost of care for Emergency Department patients. Following a Plan, Do, Study, Act design, a quality team developed an education strategy, analyzed data trends, and provided group and individualized feedback to encourage the adoption of the practice change. This project achieved an overall 55.9% reduction in CT Head utilization rates resulting in a potential cost savings of $158,974.
Problem: The aim of this project was to evaluate if implementing the Pediatric Emergency Care Applied Research Network (PECARN) Head CT Guidelines, would decrease the unnecessary Head CT Utilization rate for 1) the intermediate-risk minor head injury pediatric patients and 2) all risk category Head Injured pediatric patient
Measurement: This project used Tableau and Excel to track, analyze, and report the findings. Ranking charts and graphs with trendlines were used to relay how groups were performing
Analysis: A PDSA design was used for the adoption of standardized pathways, education plans, performance feedback, and unblinded data reports were used to provide groupwide and individual performance trends. Performance was portrayed in percentages of Head CT utilization rates against the total number of head injury patients
Implementation: A Minor Head Injury Toolkit was used by the Michigan Emergency Department Improvement Collaborative to improve the adoption of the guidelines. A PECARN Head CT rule pocket card was customized to highlight the treatment methods within the intermediate-risk pediatric head injury category, and physician champions educated peers on the guidelines