Radiation danger, repeated CTs by frequent flyers

[Emergent]

We are currently tracking opiate usage by frequent flyers, to protect them from harm. A CT scan has 150-1100x the radiation dosage of a standard x-ray. Yet, we are handing them out like candy to frequent flyers. I'm thinking of your chronic, abdominal pain pt, often a young or middle aged woman. They get repeated CT scans, often as defensive medicine, not sound holistic practice.

A kid bumps his head and he gets a CT. A guy falls and twists his back, and off to CT. I think they are over used, and the population that runs to the ER for every little bump, bruise, or stomach ache is getting over-exposed to radiation.

I think this is irresponsible medicine, but unfortunately, providers are forced to cover their behinds, and the public expects CTs and doesn't realize the dangers. And, they are a nice, fat billable charge for the hospital too.

[turnforthenurse, MSN, NP]

But you know it won't ever be anything radiation-related that kills her, it'll be a bleed the one time she falls and no one does a CT scan. Hello, Murphy: your law-fu is strong.

Exactly. I agree, our ED does A LOT of CTs but I feel like it's a CYA thing with our providers.

[LakeEmerald]

This is why people need to visit their primary MD and not come to the ED for nonemergent conditions. The problem is, too many of my ED patients think a mild headache, a vomiting episode, or abdominal pain x 1 day ARE emergent conditions. Then, because they came to ED, they are treated as possible emergent conditions, therefore reinforcing the patients' perceptions that their minor discomforts ARE emergencies. Then the cycle continues. Ugh.

To make matters worse, as Pixie mentioned, the one time out of six the CT isn't ordered will be the time the true emergency occurs.

[exit96]

Seen one of our freq's two times this past 7 days. Back/ flank pain as usual. Been scanned 16 times in the pat 2 years, with nothing identified besides UTI...The Provider said, "no CT and no narc's"...this stuff has to stop. Providers are under the microscope. Patient Satisfaction (although only immediate satisfaction based on emotions instead of good practice) is destroying sound medical decision making.

[Racer15, BSN, RN]

My nephew had three head CTs in a month for a skull fx with a minor brain bleed at two months old. The initial head CT I understood. The follow-up head CT 24 hours later, I understood. We fought the last one as he was entirely a symptomatic and the second CT showed that the bleed had already shrunk significantly. They told us CPS would be informed if we refused the final CT and were bullied into it. Our main concern was what kind of effects that level of radiation will have on him later in life, they didn't care. The amusing thing is that if we had never brought him in for the initial injury, he would have had zero CTs with the exact same outcome. My ER sends you to CT no matter how often you roll through the doors. The mid-levels are the worst about it, even if you've been to another facility in the past week with a CT, they will order old records but CT again anyways.