The role of cognitive bandwidth in more cost-effective CT scan usage: A study in reducing “prevention costs”

Background: Research has shown preventative care measures aimed at reducing healthcare costs can actually increase them. The objective of this study was to observe the relationship between cognitive capacity and preventative CT scan use relative to best practice. Methods: Conducted in July 2012, the study involved a retrospective analysis of 825 consecutive head CT examinations performed over one month by ED physicians crossing three shifts in a large Detroit medical center. Military Acuity Model data mining and modeling techniques were used to examine the relationship between CT head yield to order timing in terms of cognitive capacity and decision fatigue relative to health risk reconciliation. Results: The study showed the number of CT scans ordered increased as physician shifts progressed, while the test value to clinical management decreased. Cognitive capacity was assumed to be at its highest at the start of physician shifts (when Decision Fatigue was lowest); Results indicated physicians were better able to evaluate CT scan use risks and trade-offs. Translating the study results into actual dollar amounts showed an opportunity cost of 26.7%, or more than $43,000 per month, for CT head/brain scan use alone. Conclusions: Ensuring the management of CT scan usage at the levels of efficiency demonstrated when the study physicians were performing at the level of their In-House Best Practice, is critical to maintaining high levels of patient care at the least possible cost. There is more than $1 million in potential annual cost savings attributable to this phenomenon of cognitive bandwidth affecting radiology decision-making for the average U.S. hospital.