The influence of education on appropriateness rates for CT pulmonary angiography in emergency department patients.
OBJECTIVE
To evaluate appropriate utilization rates for computed tomography (CT) pulmonary angiography (CTPA) in a tertiary center emergency department (ED), before and after a health care provider educational intervention.


METHODS
Institutional Review Board-approved retrospective study. Records for 100 consecutive CTPA studies ordered by the ED were retrieved from a radiology database. Appropriateness rates for the studies were determined using information from existing literature (clinical decision rules and society guidelines). Where pretest probability was not performed, it was calculated by the authors. After ED health care provider education regarding appropriateness guidelines through a dedicated lecture and question-and-answer session, appropriateness rates for another 100 consecutive CTPA ordered by the ED were calculated.


RESULTS
In the preeducational intervention, 1% of patients had Wells scores performed, 65% were women, and 29% were age <40 years. Before CTPA, 40% patients had d-dimer testing, 15% of patients had a "negative" d-dimer, 17% had alternative explanations for chest pain, and 76% had low or intermediate pretest probability. Appropriateness rates for CTPA was 7%, and 8% of studies were positive. Postintervention, no Wells scores were performed, 59% were women, and 34% <40 years. Before CTPA, 32% of patients had d-dimer, 16% had a "negative" d-dimer, 22% had alternative explanations for chest pain, and 84% had low or intermediate pretest probability. The appropriateness rate for CTPA was 6% and 10% of studies were positive.


CONCLUSIONS
A single educational intervention had no effect on appropriate utilization rates for CTPA. Repeated and sustained educational interventions may help improve imaging ordering pathways through the ED and other departments.
Department of Radiology, Texas Scottish Rite Hospital for Children, Dallas, TX, USA.
Yassine
Y
Kanaan
Ursula D
UD
Knoepp
Aine M
AM
Kelly
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011361:Professional Competence / Q000706:statistics & numerical data*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011871:Radiology / Q000193:education* / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review; D055815:Young Adult
Pulmonary embolism; appropriateness; computed tomography; deep venous thrombosis; educational intervention; venous thromboembolism