The fiscal impact of repeat imaging in a pediatric orthopedic clinic.

Abstract

Many patients present to an initial pediatric orthopedic clinic visit without bringing previously obtained x-rays (XRs), leading to repeat imaging, unnecessary radiation exposure, and increased health care costs. Importing images to the picture archiving and communication system and the use of cloud-based medical image-sharing software systems result in the reduction of reimaging rates and health care costs. Unnecessary duplicative XR imaging was recognized in our pediatric orthopedic clinic as an area for quality improvement. Our purpose was to determine the magnitude of the problem and the feasibility of decreasing total visit charges through electronic retrieval of previous XRs. Data collection occurred from May 22, 2019, through June 22, 2019, in the orthopedic trauma clinics at the main campus of a quaternary care pediatric hospital in the northeast United States and its three satellite locations. The number of patients who did not bring XRs to their initial orthopedic visit and the type of XR ordered were recorded by clinicians. A retrospective chart audit was also completed for comparison. Of 699 new patient visits, 77 (11%) did not bring previous XRs. This resulted in total reimaging charges of $33,326, representing 30%-50% of total visit charges. Retrospective chart audit identified 60% more new patients than the clinicians. Electronic retrieval of XRs in pediatric orthopedic clinics can decrease duplicative charges, radiation exposure, and health care waste. It can also contribute to successful care of patients via virtual visits in times of restricted access such as a pandemic.