High Scan Volume with Low Positive Scan Rate in Highest Utilizers: Computed Tomography Pulmonary Angiography in the
Himanshu Rawal1, Oluwatoyosi Ipaye2, Amit D Kalaria3
1MedStar Good Samaritan Hospital, Baltimore, Maryland; MedStar Union Memorial Hospital, Baltimore, Maryland.
Most emergency department physicians ordering computed tomography pulmonary angiography (CTPA) had a high positive scan rate (PSR). However, a small group of high-volume CTPA users had a lower PSR, suggesting targeted feedback could improve diagnostic accuracy.
Area of Science:
- Emergency Medicine
- Radiology
- Health Services Research
Background:
- Examining computed tomography pulmonary angiography (CTPA) utilization in emergency departments (EDs).
- Identifying predictors of CTPA results and scan performance.
Purpose of the Study:
- Determine the positive scan rate (PSR) for ED CTPA among attending physicians.
- Analyze PSR based on physician scan volume categories.
Main Methods:
- Retrospective review of 10,032 ED CTPA scans from a multisite medical system in 2017.
- Categorization of attending physicians by the number of CTPA scans ordered.
Main Results:
- Most physicians (80%) ordered ≤60 CTPAs with an 8.8% PSR.
- A small group (3%) ordering >100 CTPAs accounted for 32% of scans, with a 5.5% PSR.
Conclusions:
- Low- to mid-volume CTPA users showed a higher PSR compared to high-volume users.
- Targeted performance feedback for high-volume CTPA prescribers may enhance ED diagnostic efficiency.
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