Impact of education on physician attitudes toward computed tomography utilization and consent.

BACKGROUND: There are risks to ordering computed tomography (CT) scans. OBJECTIVE: We set out to determine whether emergency physician attitudes and their predictions of CT ordering behaviors could be influenced by education. METHODS: We surveyed emergency physicians at a Level I trauma center with a yearly census of 74,000. Physicians were given a baseline survey that encompassed demographics, attitudes toward CT informed consent, and ordering behaviors. After receiving an education session regarding CT risks, each participant received a follow-up survey. Data analysis was performed using frequencies and chi-squared. RESULTS: Seventy-five physicians participated; 69% residents and 31% attendings; 34% were female and 66% male. Thirteen percent reported they did not know if informed consent was required for CT scans obtained in the Emergency Department. Pre-education, 89% reported sometimes ordering a CT scan due to a consultant request that they felt was not indicated, and 92% reported that they sometimes ordered a CT scan to appease a patient or family. Eighty-five percent reported that they sometimes ordered a CT scan defensively due to malpractice risk. After education, physicians were more likely to believe a patient should give informed consent before CT (p<0.01) and predicted that they would be more likely to discuss the risks/benefits of CT with their patients all of the time (p=0.001). CONCLUSION: After education about the risks of CT utilization, emergency physicians were more likely to believe that patients should give informed consent before CT scan and predicted that they would be more likely to discuss the risks and benefits of CT with their patients.

Patient attitudes regarding consent for emergency department computed tomographies.

INTRODUCTION: Little is known about patient attitudes towards informed consent for computed tomography (CT) in the emergency department (ED). We set out to determine ED patient attitudes about providing informed consent for CTs. METHODS: In this cross-sectional questionnaire-based survey study, we evaluated a convenience sample of patients' attitudes about providing informed consent for having a CT at 2 institutional sites. Historically, at our institutional network, patients received a CT at approximately 25% of their ED visits. The survey consisted of 17 "yes/no" or multiple-choice questions. The primary outcome question was "which type of informed consent do you feel is appropriate for a CT in the Emergency Department?" RESULTS: We analyzed 300 survey responses, which represented a 90% return rate of surveys distributed. Seventy-seven percent thought they should give their consent prior to receiving a CT, and 95% were either comfortable or very comfortable with their physician making the decision regarding whether they needed a CT. Forty percent of the patients felt that a general consent was appropriate before receiving a CT in the ED, while 34% thought a verbal consent was appropriate and 15% percent thought a written consent was appropriate. Seventy-two percent of the ED patients didn't expect to receive a CT during their ED visit and 30% of the ED patients had previously provided consent prior to receiving a CT. CONCLUSION: Most patients feel comfortable letting the doctor make the decision regarding the need for a CT. Most ED patients feel informed consent should occur before receiving a CT but only a minority feel the consent should be written and specific to the test.

Research priorities for the influence of gender on diagnostic imaging choices in the emergency department setting.

Diagnostic imaging is a cornerstone of patient evaluation in the acute care setting, but little effort has been devoted to understanding the appropriate influence of sex and gender on imaging choices. This article provides background on this issue and a description of the working group and consensus findings reached during the diagnostic imaging breakout session at the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes." Our goal was to determine research priorities for how sex and gender may (or should) affect imaging choices in the acute care setting. Prior to the conference, the working group identified five areas for discussion regarding the research agenda in sex- and gender-based imaging using literature review and expert consensus. The nominal group technique was used to identify areas for discussion for common presenting complaints to the emergency department where ionizing radiation is often used for diagnosis: suspected pulmonary embolism, suspected kidney stone, lower abdominal pain with a concern for appendicitis, and chest pain concerning for coronary artery disease. The role of sex- and gender-based shared decision-making in diagnostic imaging decisions is also raised.