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.