Managing CT Scan Ordering During Contrast Shortage

Table of Contents

1. Introduction
2. The Impact of the Contrast Shortage on Hospital Operations
3. Nursing's Role in CT Scan Ordering
4. Challenges Faced in Prioritizing CT Scans for Stroke Alerts
5. Collaboration with State Stroke Work Groups
6. Designated Tiers for Prioritization of CT Scans with Contrast
7. Prioritization Communication and Decision Making
8. Integration of Best Practice Advisories in Decision Making
9. The Role of Radiologists in Addressing Provider Queries
10. Collaboration and Resource Utilization in Managing the Contrast Shortage

Article

Introduction

In recent times, our hospital has been facing a shortage of contrast, which has had a significant impact on our operations. As a nursing leader, I have been dealing with the complexities of prioritizing CT scan orders, where previously it was solely the responsibility of the provider. However, involving nursing in the decision-making process has proven to be beneficial in empowering the bedside nurses to advocate for patients and ensure appropriate utilization of resources.

The Impact of the Contrast Shortage on Hospital Operations

The contrast shortage has forced us to reconsider our approach to ordering certain diagnostic images. Previously, if a patient presented with stroke symptoms but had unclear findings or inconsistent medical history, providers would order a CT perfusion as a precautionary measure. However, due to the scarcity of contrast, we had to establish guidelines and draw a line in the sand. Not every patient with a gut feeling or suspicion could be activated as a stroke alert. This has prompted nurses to advocate for patients and critically evaluate the necessity of CT perfusion in each case.

Nursing's Role in CT Scan Ordering

Nursing's involvement in the decision-making process regarding CT scan ordering has been pivotal. By including nursing in the collaborative effort, we have empowered the frontline advocates for patients. Nurses are now able to contribute to the thought process and order CT scans Based on their clinical judgment. This integration of expertise ensures that the right tests are performed for the right patients, considering factors such as urgency and resource availability.

Challenges Faced in Prioritizing CT Scans for Stroke Alerts

The shortage of contrast has posed challenges in prioritizing CT scans for stroke alerts. To overcome this, our hospital has a well-established state stroke work group facilitated by the Louisiana emergency response network. The group benefits from the guidance provided by the state stroke medical director. This guidance helps facilities with varying capabilities to determine priorities based on the patient's last known well, availability of MRI or CT options, and the ability to perform CTAs or CT perfusions. Having these directives in place helps streamline decision-making and ensure that patients receive the urgent care they require.

Collaboration with State Stroke Work Groups

Being a part of the stroke work group in Louisiana has been extremely advantageous. The group provides valuable direction and support to healthcare facilities grappling with the contrast shortage. By sharing best practices and offering designated tiers for prioritizing CT scans with contrast, the work group enables facilities to make informed decisions. This collaboration ensures that patients receive the appropriate level of care based on their clinical needs and the availability of imaging resources at the respective facilities.

Designated Tiers for Prioritization of CT Scans with Contrast

To effectively manage the shortage of contrast, our hospital has implemented designated tiers for prioritizing CT scans. The tier assignment is based on the urgency or emergent need of the patient. Trauma alerts and stroke alerts receive higher prioritization due to their acuity. Conversely, routine follow-up or non-urgent CT scans fall lower on the tier system. Communicating these tiers to providers helps them make informed decisions and consider alternatives when resources are limited. Outpatient scans may be postponed if the contrast shortage is anticipated to impact the availability of resources.

Prioritization Communication and Decision Making

While our electronic medical records system does not currently have integrated best practice advisories for CT scan ordering, our multidisciplinary team plays a crucial role in prioritization. Our CT and imaging teams have taken ownership of prioritization and have established a call center for provider queries. Radiologists are readily available to address concerns about the need for emergent or urgent CT scans. This proactive approach ensures that decisions are made collaboratively, leveraging the expertise of radiologists and enhancing patient care.

Integration of Best Practice Advisories in Decision Making

Although our Current decision-making process does not incorporate best practice advisories within the electronic medical records system, our team acknowledges the importance of adapting to changing circumstances. As the contrast shortage continues, we recognize the need to explore the integration of best practice advisories to enhance decision-making and resource utilization. By leveraging technology, we aim to provide real-time guidance to providers regarding the necessity of CT scans and enable them to make well-informed decisions in a Timely manner.

The Role of Radiologists in Addressing Provider Queries

Radiologists play a crucial role in addressing provider queries related to CT scan ordering amidst the contrast shortage. Our radiologist team proactively established a call center to facilitate direct communication for decision-making. If a provider is uncertain about the urgency or necessity of a certain test, they can call the dedicated phone line and consult with a radiologist. This initiative ensures that providers have access to immediate expertise and guidance when making critical decisions regarding CT scans.

Collaboration and Resource Utilization in Managing the Contrast Shortage

In managing the contrast shortage, it is crucial not to work in isolation. Nurses, as well as other healthcare professionals, can utilize the expertise and support of various teams within the hospital. In stroke initiatives, nurses can collaborate with radiologists, interventional radiologists, CT and MRI technicians, pharmacy personnel, and the ER team. By leveraging the collective knowledge and experience of the entire team, decisions can be made in a more holistic manner, ensuring that patient care remains the top priority.

Highlights

• The contrast shortage has necessitated a reevaluation of CT scan ordering processes in hospitals.
• Involving nursing in the decision-making process empowers frontline advocates for patients.
• Prioritizing CT scans for stroke alerts is challenging but can be achieved through collaboration with state stroke work groups.
• Designated tiers help prioritize CT scans based on urgency and availability of resources.
• Clear communication channels and collaboration with radiologists aid in making informed decisions during the shortage.
• Integration of best practice advisories can further enhance decision-making in the future.
• Nurses should collaborate with various healthcare professionals to effectively manage the contrast shortage and ensure quality patient care.

FAQ

Q: How has the contrast shortage impacted hospital operations? A: The contrast shortage has forced hospitals to prioritize CT scans and reassess the necessity of certain tests, leading to a more collaborative decision-making process.

Q: What role does nursing play in CT scan ordering during the contrast shortage? A: Nursing now has a significant role in the decision-making process, contributing their clinical judgment and advocating for patients' needs in CT scan ordering.

Q: How are CT scans prioritized for stroke alerts amid the contrast shortage? A: Collaborating with state stroke work groups allows hospitals to establish protocols and designated tiers for prioritizing CT scans based on urgency and availability of resources.

Q: Are there integrated best practice advisories in the decision-making process? A: While the electronic medical records system may not currently have integrated best practice advisories, hospitals are exploring options to enhance decision-making using technology.

Q: How do radiologists assist in addressing provider queries during the shortage? A: Radiologists have established call centers to offer immediate expertise and guidance to providers uncertain about the necessity of CT scans.