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

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.