Optimizing Outpatient Oral Contrast Use in Abdominal CT-A Radiology Pandemic Response Initiative to Reduce Patient Time in the Waiting Room and Reduce Costs, While Improving Patient Experience.

Abstract

Purpose: The aim was to reduce outpatient wait time and improve patient experience by optimising oral contrast use. Methods: Our multidisciplinary stakeholder collaboration implemented two simultaneous interventions: (1) Creation of 'oral contrast policy', limiting recommended indications. (2) Creation of a new shorter oral contrast regime (30 vs 60min). We conducted a retrospective service evaluation of oral contrast use in outpatient (OP) abdominal CT at baseline and post-intervention. Patient wait times were measured and per-patient cost-savings were reported. An image quality review was performed by 2 blinded abdominal radiologists. Patient experience was evaluated with a standard voluntary survey. Statistical analysis was performed comparing baseline and evaluation outcomes using Chi-square or Fisher Exact test for categorical variables and Student's t-test or ANOVA for continuous data. Results: Over 1-month periods, OP CT scans were assessed in baseline (pre-pandemic) n = 575, baseline (pandemic) n = 495 and post-intervention n = 545 groups. Oral contrast use reduced from 420/575, 73.0% at baseline to 178/545, 32.7% post intervention. The turn-around time reduced by 15.8minutes per patient from 70.3 to 54.5minutes, P < .001 (Interventions 1 and 2). The diagnostic quality did not differ between the oral contrast regimes (Intervention 2, P = 1.0, P = .08). No repeat CTs were needed due to lack of oral contrast (Intervention 1) or poor opacification (Intervention 2). There was oral contrast cost reductions of 69.1-78.4% (P < .001). Patients reported their overall experience was improved post-intervention (Interventions 1 and 2). Conclusions: Optimising the CT oral contrast service through judicious use and a shorter regime, reduced patient wait times, improved patient experience and preserved diagnostic quality.