"Choosing Wisely" Imaging Recommendations: Initial Implementation in New England Emergency Departments

Area of Science:

• Emergency Medicine
• Health Services Research
• Radiology

Background:

• The American College of Emergency Physicians (ACEP) launched the Choosing Wisely recommendations in 2013 to reduce unnecessary imaging in low-risk patients.
• The Reduce Avoidable Imaging Initiative, started in 2016, aimed to implement these recommendations.
• The adoption of these evidence-based interventions in New England emergency departments (EDs) was previously unassessed.

Purpose of the Study:

• To evaluate the extent to which New England EDs implemented interventions supporting ACEP Choosing Wisely imaging recommendations.
• To determine if provider-specific audit and feedback mechanisms for imaging were in place.

Main Methods:

• A survey was distributed in 2015 to 195 hospital-affiliated EDs across the six New England states.
• Follow-up mailings were conducted to non-responders.
• Descriptive statistics and Fisher's exact test were used for data analysis.

Main Results:

• 169 EDs (87% response rate) responded to the survey.
• 60% of EDs implemented at least one Choosing Wisely imaging intervention, with 57% using guidelines/policies and 28% using computerized decision support.
• Provider-specific audit and feedback was implemented in 40% of EDs.

Conclusions:

• Most New England EDs had adopted guidelines for Choosing Wisely imaging recommendations within a year of their release.
• A minority of EDs utilized provider-specific audit and feedback or computerized decision support systems.
• Widespread adoption of multiple evidence-based interventions is needed to enhance patient-centered and resource-efficient care.