Doctors in the United States are looking north for help determining when diagnostic tests are needed in hospital emergency rooms. A paper recently published in the prestigious JAMA Internal Medicine features a list of the top five ways to reduce unnecessary procedures, three of which are based on work by physician-scientists at The Ottawa Hospital Research Institute, which is affiliated with the University of Ottawa.
As in most developed countries, the cost of medical care in the U.S. particularly in emergency departments is growing at an alarming rate. Between 2003 and 2011, the average cost to treat a person in a U.S. emergency room rose 240%, to $1,354 from $560, according to a study by the U.S. Agency for Healthcare Research and Quality. It is estimated that diagnostic tests, treatments and hospitalizations ordered by emergency room doctors account for 10% of annual health care expenditures in the U.S.
Physician-scientists at the Ottawa Hospital have gained a reputation for developing easy-to-follow clinical decision rules to determine whether diagnostic tests for particular ailments are needed. These rules, which have proven to be remarkably accurate, are now being recommended to U.S. emergency room doctors as a way to save time and money, and to spare patients from unnecessary and often uncomfortable diagnostic procedures.
It is wonderful to see that the rules developed right here in Ottawa are gaining traction in the United States and elsewhere in the world, said Dr. Duncan Stewart, professor of medicine at the University of Ottawa, chief executive officer and scientific director at the Ottawa Hospital Research Institute, and vice-president of research at the Ottawa Hospital. That we developed three of the top five items on this list provides further evidence of the global impact of our research.
The made-in-Canada clinical decision rules include:
- Canadian C-Spine Rule, used to determine if a person needs a cervical spine CT scan (developed by Dr. Ian Stiell)
- Canadian CT Head Rule, used to determine if a person needs a head CT scan after a mild trauma (developed by Dr. Ian Stiell)
- Wells Rule, a procedure to diagnose blood clots that are blocking a main artery in a lung (pulmonary embolisms) (developed by Dr. Phillip Wells)
We were not surprised that three of the five top-ranked items were based on clinical decision tools developed in Ottawa, said Dr. Jeremiah Schuur of Brigham and Women's Hospital Department of Emergency Medicine in Boston, Massachusetts. The physician-researchers from Ottawa are international leaders in developing useful bedside tools for critical diagnostic questions. It is a remarkable feat.
A four-phase consensus approach was used to determine the top five list. A technical panel was convened, which relied on expert opinions and results of a clinician survey to rank potentially avoidable clinical procedures.
Having a group of U.S. researchers independently recommend our work in a high-profile journal such as JAMA Internal Medicine is tremendous validation, and a good indication that these evidence-based clinical decision tools are reliable, said Stiell, a senior scientist at the Ottawa Hospital Research Institute and emergency physician at the Ottawa Hospital.
Many of the clinical decision rules pioneered in Ottawa are now being used throughout Europe and Asia, including the world-renowned Ottawa Ankle Rules, developed by Stiell, who is also chair of the Department of Emergency Medicine in the University of Ottawa's Faculty of Medicine.
These made-in-Canada tools clearly have a positive impact on patients globally, which is wonderful, said Dr. Jack Kitts, president and CEO of the Ottawa Hospital. World class research is being translated into world class medical care right here in Ottawa.
About the University of Ottawa
The University of Ottawa is the largest bilingual university in the world. Students can study in English, in French, or in both languages. Located in the capital of Canada, a G8 nation, we are committed to research excellence and encourage an interdisciplinary approach to knowledge creation. Our breakthroughs in health, science, social sciences and the humanities attract global attention, reflecting our ranking among Canada's top 10 research universities and our ongoing drive to discover.
About the Ottawa Hospital Research Institute
The Ottawa Hospital Research Institute (OHRI) is the research arm of the Ottawa Hospital. It is an affiliated institute of the University of Ottawa, closely associated with its faculties of Medicine and Health Sciences. OHRI includes more than 1,700 scientists, clinical investigators, graduate students, postdoctoral fellows and staff conducting research to improve the understanding, prevention, diagnosis and treatment of human disease.
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