title: Optimizing CT Pulmonary Angiogram Utilization in a Community Emergency Department: A Pre- and Postintervention Study.
abstract: OBJECTIVE
  Optimizing the utilization of CT pulmonary angiogram (CTPA) for the diagnosis and workup of acute chest pain can provide an opportunity to reduce unnecessary radiation and health care system expense.
  
  
  METHODS
  An attempt to improve CTPA utilization began by measuring overall department and clinician-specific utilization. This was bolstered by retrospectively evaluating patient charts for pulmonary embolism scoring criteria and D-dimer utilization so as to better understand gaps in diagnostic workup. The department-wide and individualized metrics were then provided to each emergency department clinician and differences between the pre- and postintervention data were evaluated.
  
  
  RESULTS
  The percentage of positive CTPAs did not change significantly at 8.7% and 9.2% in the pre- and postintervention groups, respectively. Similarly, the workup of patients based on retrospective PERC and Wells-score criteria did not significantly improve after the intervention. However, the percentage of CTPAs ordered on low D-dimer patients did decrease significantly post-intervention. Further observational analysis uncovered marked variability in clinician ordering behavior and diagnostic rates.
  
  
  CONCLUSIONS
  Overall, such an intervention seems to have a limited, though not insignificant, impact on the workup of suspected pulmonary embolism. Calculating provider-specific utilization metrics allows both the radiologist and clinician to better understand opportunities to improve health care delivery.
authors.affiliation: Department of Radiology, University of California, San Diego, San Diego, California. Electronic address: booker.michael@gmail.com.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Booker
authors.affiliation: Imaging Healthcare Specialists, San Diego, California.
authors.forename: John O
authors.initials: JO
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control* / Q000706:statistics & numerical data*; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000097:blood* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D058996:Quality Improvement / Q000706:statistics & numerical data; D014600:Utilization Review; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: CT pulmonary angiography; D-dimer test; Pulmonary Embolism Rule-out Criteria; Wells score; pulmonary embolism; quality improvement; utilization review