Effect of mandatory radiology consultation on inpatient imaging use. A randomized controlled trial

R. L. Bree, E. A. Kazerooni and S. J. Katz
Department of Radiology, University of Michigan Medical Center, Ann Arbor 48109-0030, USA.

OBJECTIVE: To determine if a mandatory radiology consultation service can decrease radiology resource use on inpatient internal medicine services. DESIGN AND SETTING: Randomized controlled trial on 4 internal medicine services at a university hospital. PATIENTS AND OTHER PARTICIPANTS: Six radiologists performed the intervention on 2 internal medicine services over a 12-month period. A total of 1022 patients were admitted to the 2 intervention services and 1178 patients were admitted to the 2 control services. Each was staffed by an attending internist and 3 house officers. INTERVENTION: Each radiology examination required approval by the attending radiologist before it was performed. MAIN OUTCOME MEASURE: Relative resource costs (relative value units [RVUs]), number of examinations per patient, proportion of patients with 1 or more tests, and mean length of stay (LOS). RESULTS: Mean RVUs for the intervention group were 356.1, and for the control group, 336.0 (P=.5). Mean examinations per patient for both groups was 4.4. Mean LOS for the intervention group was 6.0 days, and for the control group, 6.1 days (P=.8). CONCLUSIONS: An inpatient radiology consultation service, with a goal to reduce resource use, did not achieve its goal. A more appropriate use of time and expense for radiology utilization management may be in the outpatient setting.

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