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.
Background:
We examined utilization patterns and predictors of computed tomography pulmonary angiography (CTPA) results in the emergency department (ED).
Objectives:
We retrospectively determined ED CTPA positive scan rate (PSR) among ED attendings based on a system that grouped attendings into scan quantity categories through >100.
Methods:
We manually reviewed all scans ordered in 2017 in EDs in a multisite medical system.
Results:
Of 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%).
Conclusion:
Most 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.
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