Impact of a Collaborative Small Bowel Obstruction Imaging and Care Protocol with the General Surgery Service on Radiology Workflow and Resource Utilization

Purpose: Small bowel obstruction (SBO) is a common cause of diagnostic imaging, hospital admission, and surgical consultation. The general surgery service at our institution collaborated with the radiology department to implement a new protocol for patients with SBO. Patients with suspected SBO often undergo initial CT imaging without oral contrast. Prior to the new protocol, it was usual for a second CT with oral contrast to be performed to confirm the diagnosis of SBO and guide further management. The new protocol eliminates the second CT, using oral Gastrografin® and serial abdominal radiographs for further assessment in clinically stable patients. The purpose of this study is to assess the impact of this protocol on the radiology department workflow and resource utilization.

Methods/Materials: A retrospective cohort study was conducted on patients from the emergency department with SBO as diagnosed initial abdominopelvic CT and for whom the general surgery service was consulted. Patients in the control group were selected retrospectively based on ICD-10 diagnosis codes for SBO who underwent two consecutive abdominopelvic CT scans within 24 hours, one after the administration of oral contrast and one without, prior to implementation of the new protocol. Metrics pertaining to radiology workflow and resource utilization, including ionizing radiation exposure, contrast media utilization, and CT technologist time, were recorded for both groups.

Results: A total of 18 patients were included in the experimental group with the new SBO imaging protocol. 38 patients were included in the control group. Total effective dose (mSv) and CT technologist time were significantly less with the new protocol (p=0.02 and p< 0.001, respectively). There was a trend for less use of intravenous contrast media in the experimental group relative to the control group, however, this was not statistically significant (p=0.06).

Conclusions: The implementation of a collaborative SBO imaging and care algorithm between general surgery and radiology resulted in reduced effective dose to patients and decreased CT technologist time. Contrast media use also decreased with the new protocol, although this was not significantly significant.