{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:52:07Z","timestamp":1777877527799,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Choosing Wisely Canada recommends against the use of nasal bone X-rays for the evaluation of nasal fractures. The goal of this quality improvement project was to reduce the number of nasal bone X-rays ordered at our institution by 50% by 1\u2009year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The Institute for Healthcare Improvement Model for Improvement was used, and a pre- and post-intervention study was conducted. Change ideas included the following: a clinical decision support tool, provider surveys, and education. The number of X-rays ordered monthly was monitored. Financial cost (labor, materials, and overhead) was assessed. Environmental impact was extrapolated based on carbon dioxide equivalent emissions (CO\n                      <jats:sub>2<\/jats:sub>\n                      e). Balancing measures included the use of computed tomography (CT) scans. Analysis included summary statistics, statistical process control charting, and unpaired t-tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There was a 73% reduction in total X-rays ordered from 197 pre-intervention (September 2021-November 2022) to 58 post-intervention (December 2022-February 2024). There was a statistically-significant decrease in difference of means of 2.6 X-rays\/month (4.9 vs 2.3, pre vs post;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), an average monthly reduction of 53%. There was special cause variation after implementation. Cost savings was $5534.98, and environmental footprint reduction was 111.2\u2009kg of CO\n                      <jats:sub>2<\/jats:sub>\n                      e. There was no compensatory increase in the number of CT scans ordered.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Implementation of a clinical decision support tool and education resulted in a significant reduction in the number of nasal bone X-rays ordered for the evaluation of nasal fractures. This Choosing Wisely Canada project ultimately reduces unnecessary investigations for patients, saves health care costs, and reduces environmental impact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19160216251336681","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T07:46:36Z","timestamp":1747727196000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Reducing Unnecessary X-Rays for Nasal Fractures: A Quality Improvement Project"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5884-2110","authenticated-orcid":false,"given":"Jess","family":"Rhee","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Kelton","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, London Health Sciences Centre, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheena","family":"Belisle","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, London Health Sciences Centre, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7609-5988","authenticated-orcid":false,"given":"Agnieszka","family":"Dzioba","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leigh","family":"Sowerby","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Simpson","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, London Health Sciences Centre, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5460-3155","authenticated-orcid":false,"given":"Julie E.","family":"Strychowsky","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/2292550317749535"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.5847\/wjem.j.1920-8642.2022.014"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1700801"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2019.102295"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/014107689408700313"},{"key":"e_1_3_3_7_2","unstructured":"Martin LA MK. 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