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Emergency department variation in utilization and diagnostic yield of advanced radiography in diagnosis of pulmonary embolus.

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Citation: Journal of Emergency Medicine. 46(6):791-9, 2014 Jun.PMID: 24636611Institution: MedStar Washington Hospital CenterDepartment: Emergency MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Emergency Service, Hospital/sn [Statistics & Numerical Data] | *Hospitals/sn [Statistics & Numerical Data] | *Physician's Practice Patterns/sn [Statistics & Numerical Data] | *Pulmonary Embolism/ra [Radiography] | *Pulmonary Embolism/ri [Radionuclide Imaging] | *Tomography, X-Ray Computed/ut [Utilization] | Adult | African Americans | Age Factors | Chest Pain/et [Etiology] | Clinical Competence | Dyspnea/et [Etiology] | Emergency Medicine/ed [Education] | Female | Humans | Internship and Residency | Male | Middle Aged | Pulmonary Embolism/co [Complications] | Radionuclide Imaging/ut [Utilization] | Retrospective Studies | Sex FactorsLocal holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:

0736-4679

Name of journal: The Journal of emergency medicineAbstract: BACKGROUND: There is growing pressure to measure and reduce unnecessary imaging in the emergency department.CONCLUSIONS: Although we found significant variation in utilization of advanced radiography for PE and diagnostic yield at the hospital level, there was no significant variation at the provider level after adjusting for patient-, hospital-, and provider-level factors.Copyright � 2014 Elsevier Inc. All rights reserved.METHODS: Retrospective chart review of all adult patients presenting to four hospitals from January 2006 through December 2009 who had a computed tomography or ventilation/perfusion scan to evaluate for PE. Demographic data on the providers ordering the scans were collected. Diagnostic yield (positive scans/total scans ordered) was calculated at the hospital and provider level. The study was not designed to assess appropriateness of imaging.OBJECTIVE: We study provider and hospital variation in utilization and diagnostic yield for advanced radiography in diagnosis of pulmonary embolism (PE) and to assess patient- and provider-level factors associated with diagnostic yield.RESULTS: There was significant variation in utilization and diagnostic yield at the hospital level (chi-squared, p < 0.05). Diagnostic yield ranged from 4.2% to 8.2%; after adjusting for patient- and provider-level factors; the two hospitals with an emergency medicine residency training program had higher diagnostic yields (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.6-2.5 and OR 1.9, 95% CI 1.5-2.4). There was no significant variation in diagnostic yield among the 90 providers after adjusting for patient, hospital, and provider characteristics. Providers with < 10 years of experience had lower odds of diagnosing a PE than more experienced graduates (OR 0.8, 95% CI 0.6-0.9).All authors: Ding R, Frohna WJ, Hansen J, Kindermann DR, Maloy K, McCarthy ML, Milzman DP, Pines JMDigital Object Identifier:

http://dx.doi.org/10.1016/j.jemermed.2013.12.002

Date added to catalog: 2015-03-17

Holdings ( 1 )
Title notes ( 7 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article		Available		24636611

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: There is growing pressure to measure and reduce unnecessary imaging in the emergency department.

CONCLUSIONS: Although we found significant variation in utilization of advanced radiography for PE and diagnostic yield at the hospital level, there was no significant variation at the provider level after adjusting for patient-, hospital-, and provider-level factors.Copyright � 2014 Elsevier Inc. All rights reserved.

METHODS: Retrospective chart review of all adult patients presenting to four hospitals from January 2006 through December 2009 who had a computed tomography or ventilation/perfusion scan to evaluate for PE. Demographic data on the providers ordering the scans were collected. Diagnostic yield (positive scans/total scans ordered) was calculated at the hospital and provider level. The study was not designed to assess appropriateness of imaging.

OBJECTIVE: We study provider and hospital variation in utilization and diagnostic yield for advanced radiography in diagnosis of pulmonary embolism (PE) and to assess patient- and provider-level factors associated with diagnostic yield.

RESULTS: There was significant variation in utilization and diagnostic yield at the hospital level (chi-squared, p < 0.05). Diagnostic yield ranged from 4.2% to 8.2%; after adjusting for patient- and provider-level factors; the two hospitals with an emergency medicine residency training program had higher diagnostic yields (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.6-2.5 and OR 1.9, 95% CI 1.5-2.4). There was no significant variation in diagnostic yield among the 90 providers after adjusting for patient, hospital, and provider characteristics. Providers with < 10 years of experience had lower odds of diagnosing a PE than more experienced graduates (OR 0.8, 95% CI 0.6-0.9).

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