• J Emerg Med · Jul 2020

    High Scan Volume with Low Positive Scan Rate in Highest Utilizers: Computed Tomography Pulmonary Angiography in the Emergency Department.

    • Himanshu Rawal, Oluwatoyosi Ipaye, Amit D Kalaria, Radhika Vij, Jeffrey S Dubin, Lyn Camire, and David S Weisman.
    • MedStar Good Samaritan Hospital, Baltimore, Maryland; MedStar Union Memorial Hospital, Baltimore, Maryland.
    • J Emerg Med. 2020 Jul 1; 59 (1): 21-24.

    BackgroundWe examined utilization patterns and predictors of computed tomography pulmonary angiography (CTPA) results in the emergency department (ED).ObjectivesWe retrospectively determined ED CTPA positive scan rate (PSR) among ED attendings based on a system that grouped attendings into scan quantity categories through >100.MethodsWe manually reviewed all scans ordered in 2017 in EDs in a multisite medical system.ResultsOf 10,032 ED CTPAs, 6168 were ordered by 153 ED attendings. Most attendings (123/153; 80%) ordered 60 or fewer scans with relatively high PSR (259/2927, PSR 8.8%; 95% confidence interval 7.8-9.9%). Of the ED attendings, 13 (3%) ordered more than 100 scans each (1981 scans; 32% of all scans), with PSR of 5.5% (95% confidence interval 4.5-6.5%).ConclusionMost ED attendings were low- to mid-volume utilizers of CTPA and had a relatively high PSR. However, the small percentage of attendings who ordered more than 100 scans each accounted for a large percentage of the total scan volume and had a relatively low PSR. These findings suggest that sharing of performance feedback and best practices in the highest utilizers could help to improve CTPA PSR in the ED.Copyright © 2020 Elsevier Inc. All rights reserved.

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