title: Is e-mail communication effective in changing ordering patterns in the emergency department? A case study of computed tomography for pulmonary embolus.
abstract: OBJECTIVE
  We sought to evaluate the effectiveness of e-mail communication to reduce the utilization of computed tomography for pulmonary thromboembolism (PE) in young patients (aged 40 and under) in our institution.
  
  
  METHODS
  An e-mail was sent to all of our institution's emergency department (ED) physicians in response to a series of negative PE studies in young females. The periods 90 days before and 90 days after were evaluated to assess the total number of PE studies performed in patients aged 40 and younger, the rate of positivity, and the utilization of D-dimer and ventilation/perfusion scans during each period.
  
  
  RESULTS
  Over the 180-day period, a total of 65 PE studies were ordered in patients aged 40 and younger in the ED. Studies were positive for PE in 1 of 33 (3%) before the e-mail and 4 of 32 (12.5%) after (P = .343). There was no difference in the number of D-dimer studies ordered during each period for patients studied with computed tomography. Ventilation/perfusion scanning was not performed on any ED patients younger than 40 during the 180-day period.
  
  
  CONCLUSIONS
  One-time e-mail communication was not effective in changing ED ordering habits of PE studies. Scant information exists in regard to effective clinician-to-clinician communication. Further evaluation for successful mechanisms to promote health practice reform and quality improvement is necessary.
authors.affiliation: Department of Radiology, Medical University of South Carolina, 169 Ashley Avenue, Box 250322, Charleston, SC 29425, USA.
authors.forename: L Vanessa
authors.initials: LV
authors.lastname: Hardin
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
authors.forename: James G
authors.initials: JG
authors.lastname: Ravenel
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D034742:Electronic Mail; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*