One important aspect of CT practice is the administration of contrast media. In a typical practice, contrast media are administered to more than half the patients who undergo imaging. Therefore, any significant change in contrast administration can have a substantial impact. One such development is the availability of contrast media in syringes that are prefilled by the manufacturer for use with power injectors.
STUDY DESIGN AND RESPONSE
In September 2001, a 3-page survey on this topic was distributed to 14,000 technologists certified in CT by the American Registry of Radiologic Technologists. Their response rate was 25%, and the conclusions drawn from those responses have a margin of error of ?3% at a 95% confidence level.
The geographic distribution of the respondents closely paralleled that of the US population. Virtually all respondents reported that they spent at least part of their time working with CT, and 78% worked in CT most of the time. Prefilled syringes were used with power injectors by 29% of respondents.
Technologists reported that they had a major influence on the use of prefilled syringes with power injectors (Figure 1). The reasons that facilities chose to use prefilled syringes with power injectors included saving time, improving cost effectiveness, enhancing health care quality, and improving safety. Respondents whose facilities did not use prefilled syringes cited cost-related issues as their primary concern; no other significant reasons for deciding not to use prefilled syringes were stated.
|Figure 1 Basis for decision to use prefilled syringes with power injectors.|
The average number of full-time CT technologists at facilities using prefilled syringes (5.4 employees) was approximately identical to that at nonuser facilities. There were no significant differences in average hours worked per week between users and nonusers of prefilled syringes. Nonuser facilities, however, employed 9% more part-time CT technologists, engaged 11% more contract technologists, and had 14% more job openings than user facilities with similar patient loads.
There were no significant differences between users and nonusers in the types of facilities in which respondents worked, in the days and hours of CT operation, in the type of CT equipment in use, in patient mix, in time allotted per patient, or in the percentage of patients receiving contrast.
When asked how their facilities ranked safety, economics, and technologist satisfaction, respondents reported that safety was the most important consideration and technologist satisfaction was least important, with no significant differences between prefilled syringe users and nonusers. The low ranking of technologist satisfaction is surprising, since 33% of respondents had a major influence on the decision to use prefilled syringes with power injectors. This is a clear indication that management values the technologists’ perspectives.
Respondents were asked how prefilled syringes would affect their daily work. The answers of users differed significantly from those of nonusers. Improvements in efficiency and productivity were noted by 87% of users and expected by 65% of nonusers; the amount of time spent with patients was expected to improve by 58% of nonusers and seen to have improved by 81% of users. Most users (61%) felt that the quality of health care improved when prefilled syringes were used with a power injector, while only 27% of nonusers predicted this type of improvement. Better technologist morale was cited by 61% of users and expected by 34% of nonusers. In addition, 23% of users stated that prefilled syringes increased technologist retention, while only 4% of nonusers stated that their intention to remain with their employers would improve.
|Figure 2 Advantages of administering contrast using prefilled syringes with power injectors.|
The vast majority (94%) using prefilled syringes with power injectors preferred this method of contrast administration. More than half (58%) of nonusers also stated that they would prefer this method. The advantages noted by users and predicted by nonusers are summarized in Figure 2. Users reported better control of bolus timing and flow rate, as well as improved image quality, primarily through better enhancement of tissue contrast. Users also wasted less contrast than nonusers, perhaps because manually drawn contrast is more likely to be discarded when patients cancel examinations.
There was no indication that prefilled syringes were preferred by institutions of a specific type or size. Rather, the use of prefilled syringes seemed to correlate with a more complete understanding of the direct and indirect costs of contrast, including staff time, discarded contrast, and supply requisition and storage. Users justified prefilled syringes when these cost-sensitive items were considered.