Standardizing saves radiologists $279,984
Practitioners were eased into new modes
"Different strokes for different folks" may have been appropriate for the 70s, but in the current turbulent health care environment, hospital systems must standardize practices and products in order to remain competitive.
An example of successful standardization is the contrast media utilization at three Louisiana hospitals in The Franciscan Missionaries of Our Lady Health System, located in Baton Rouge, Lafayette, and Monroe.
"While all the hospitals performed similar diagnostic radiology procedures, each used different volumes and concentrations of contrast media from different vendors," says Ken Elkins, director of imaging services. A quality initiative not only standardized the product but also the process and saved about $279,984, or 25.7%.
Although the effort began in the materials management department, the initiative itself was clinician-driven. "We knew this just couldn’t be a purchasing decision alone," says Al Cook, FASHMM, director of materials management for the system. "Clinicians had to have an equal voice."
A team of radiologists, radiology technicians, and materials management directors from each hospital worked to find a benchmark that determined the best acceptable contrast at the lowest cost.
First, they worked with imaging specialists from the contrast media vendors to acquire utilization data on the seven procedures that accounted for the majority of media used:
• cerebral angiography;
• peripheral angiography;
• computed tomography (CT) of the body;
• computed tomography of the head;
• intravenous pyelography;
• lumbar myelography;
• cervical myelography.
For each procedure, by hospital, the imaging specialists gathered the number of procedures performed annually, the contrast media concentration, the contrast media volume, unit cost, and annual cost.
Using this information, the team discussed with radiologists the variations from procedure to procedure and from hospital to hospital.
"We developed recommendations that ensured the optimal organ visualization and image quality," Elkins says. "In diagnostic radiology, we are now primarily using Omnipaque 300-50 ml with limited quantities of Omnipaque 300-10 ml, Omnipaque 240-20 ml, and Omnipaque 180-20 ml for myelography. For CT, we use Omnipaque 300-50 ml and Omnipaque 300-100 ml, with Omnipaque 240-100 ml used for chest imaging only," he says. Omnipaque is a product of Nycomed Inc. in Dallas.
In magnetic resonance imaging (MRI), the product of another vendor, Burlex, was being used. But in an effort to standardize, the team tested the Nycomed product, Omniscan, and decided to adopt it, says Billy Foster, BSRT, a team leader in radiology at St. Francis Medical in Monroe.
"We had a good working relationship with the previous vendor [Burlex] and were quite satisfied with its product. But we knew that if our three hospitals could standardize, we could reduce costs," he explains. "Anytime something may save you money, it’s worth a try."
Foster was also familiar with clinical trials from an earlier nationwide test done at the request of Burlex. "We had done more than 100 case studies in which we documented any adverse reactions, so essentially we used a similar format to gather information during the Nycomed study," he says.
Foster notes that because the Nycomed study was not a clinical trial, it was conducted more informally. "But there is still a need for good documentation," he says.
Along with patient demographics, the adapted check sheet contained spaces for the clinician to check off information about medical history, presenting symptoms, injection administrations, documentation of adverse experiences, and the radiologist role. "These questions are listed with small blocks so that they may be checked off if they apply," he says. (See sample checklist, p. 131.)
For about three weeks, Foster and team members John Brandl, BSRT and David Crocket, RT, alternated using the Burlex contrast media on one patient and the Nycomed product on the next. "If a patient was coming in for a recheck, we made sure we used the new product because that gave us a good comparison of results on the same patient," he explains.
Both products produced equal results, he says.
"Radiologists reported the same enhancement of normal and pathological structures," he says. "There were no contrast reaction. So we knew it was a matter of costs."
The Burlex packaging, Foster explains, was also contributing to waste. "Before you could only buy a certain bottle. You drew up the amount for that patient based on his or her body weight and you had to discard the rest. "Because Nycomed has three different dosages, you can use the closest to what you need."
Theresa Smith, national account director for Nycomed, says her company carries about 60-plus packaging options. "There’s just so much variability in procedure, protocol, and equipment, hospitals need a broad spectrum of options," she says.
But Smith cautions that an across-the-board edict to change concentrations won’t work. "Clinicians who have always used 200 cc of the product may find it difficult to believe that moving to 100 cc will cause a big difference in visualization," she says. "So we asked them to try for a period to move to 150 cc."
She also cautions that new equipment will affect the amount of contrast media needed. "The new scanners need a higher concentration and lower volume," Smith explains.
After six months under the new standardization, the improvement team reviewed the savings gained from the more efficient use. "In 1995, we were purchasing $1,085,917 of contrast media for these seven procedures," Cook says. "We estimated we’d save about $221,606, but actually we saved $279,984."
Foster puts it this way: "The doctors are happy; the patients are happy; and we’re getting a better price."
[For more information, contact Billy Foster, Monroe MRI Center, 501 Catalpa Street, Monroe, LA 71201. Telephone: (318) 327-4433. Or contact: Theresa Smith, Nycomed Inc., 1603 LBJ Freeway, Suite 840, Dallas, TX 75234. Telephone: (972) 241-0495.]
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