Optimizing CT Pulmonary Angiogram Utilization in a Community Emergency Department: A Pre- and Postintervention Study

Area of Science:

• Radiology
• Emergency Medicine
• Health Services Research

Background:

• Acute chest pain is a common emergency department presentation.
• CT pulmonary angiogram (CTPA) is crucial for diagnosing pulmonary embolism (PE).
• Optimizing CTPA utilization can reduce radiation exposure and healthcare costs.

Purpose of the Study:

• To evaluate an intervention aimed at improving CTPA utilization for acute chest pain.
• To assess the impact on diagnostic workup, radiation exposure, and healthcare expenses.

Main Methods:

• Measured department-wide and clinician-specific CTPA utilization.
• Retrospectively reviewed patient charts for PE scoring criteria (PERC, Wells) and D-dimer use.
• Provided individualized utilization metrics to clinicians and compared pre- and post-intervention data.

Main Results:

• Positive CTPA rates remained stable (8.7% vs. 9.2%).
• No significant improvement in workup based on PERC and Wells criteria.
• Significant decrease in CTPAs ordered for low D-dimer patients post-intervention.
• Observed marked variability in clinician ordering behavior.

Conclusions:

• The intervention had a limited but not insignificant impact on PE workup.
• Provider-specific utilization metrics can guide improvements in healthcare delivery for suspected PE.
• Further strategies are needed to optimize CTPA use and reduce unnecessary testing.