Improving Adherence to Pulmonary Embolism Evaluation Consensus Guidelines: A Multimodal Approach

Abstract

AbstractObjectiveDespite the publication of multiple widely accepted guidelines, Computed Tomography pulmonary angiography (CTPA) remains overutilized in the emergency (ED) setting for evaluating suspected pulmonary embolism (PE). We developed and evaluated a multimodal program that aimed to improve ordering provider adherence to CTPA use guidelines, and consequently positivity rate.MethodsWe retrospectively identified all CTPA studies ordered for suspected PE over three years for each provider at a single-center ED, and reviewed radiology reports to determine PE positivity. We then implemented a program that included an education session, individualized performance feedback, and discussion of possible incentives to improve guideline adherence. We prospectively collected CTPA results for the following year. Our primary outcome was the difference in positivity rate between the final preintervention year and the post-intervention year. Our secondary outcome was individual provider positivity rate between the pre-intervention and post-intervention period. We compared the primary outcome using chi-squared testing, defining statistical significance as P<0.05.ResultsWe identified 4265 CTPA studies performed during the pre-intervention period, ordered by 25 providers. 1582 studies were ordered during the final year, with an 11.00% positivity rate (174/1582). In the post-intervention year, 1339 studies were ordered, with a significantly greater positivity rate of 13.67% (183/1339, P = 0.028). For our secondary outcome, mean provider positivity rate was 11.49% during the preintervention period, and increased to 14.24% in the post-intervention period.DiscussionWe successfully implemented a multimodal program for ED providers that significantly increased the positivity rate of CTPAs ordered for suspected PE evaluation.