Leila Salehi1,2,3, Prashant Phalpher4,5, Marc Ossip5, Christopher Meaney6, Rahim Valani5,7, Mathew Mercuri7. 1. Department of Family Medicine, McMaster University, Hamilton, ON, Canada. Leila.salehi@utoronto.ca. 2. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. Leila.salehi@utoronto.ca. 3. William Osler Health System, Rm. S1.184, 2100 Bovaird Drive East, Brampton, Ontario, L6R 3J7, Canada. Leila.salehi@utoronto.ca. 4. Department of Family Medicine, McMaster University, Hamilton, ON, Canada. 5. William Osler Health System, Rm. S1.184, 2100 Bovaird Drive East, Brampton, Ontario, L6R 3J7, Canada. 6. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. 7. Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Abstract
PURPOSE: To describe the inter-physician variability in the utilisation rate and diagnostic yield of computed tomography pulmonary angiography (CTPA) among a group of emergency department (ED) physicians working in a similar clinical environment. METHODS: We collected data on all CTPA studies ordered by ED physicians at three affiliated sites during a 2-year period between January 1, 2016, and December 31, 2017. For each physician, we calculated individual CTPA utilisation rate (total number of CTPAs ordered per 1000 ED visits) and diagnostic yield (percentage of CTPAs that were positive for PE). Additional analysis was carried out in order to identify the highest orderers of CTPA and their diagnostic yield. RESULTS: Seventy-seven ED physicians who collectively ordered a total of 2788 CTPAs were included in the study. Utilisation rates ranged from 1.1 to 22.2 CTPA per 1000 ED visits (median: 5.2 CTPA/1000 ED visits; 25%ile: 3.6 CTPA/1000 ED visits; 75%ile: 7.9 CTPA/1000 ED visits) and the CTPA diagnostic yields ranged from 0% to 33% (median: 9.1%; 25%ile: 5.2%; 75%ile: 16.1%). Those physicians in the lower quartile for ordering rate had a higher mean diagnostic yield when compared to the higher quartiles. CONCLUSION: The findings of this study demonstrate variability in CTPA ordering patterns and diagnostic yields among physicians working within the same clinical environment. There is some suggestion that those physicians who order disproportionately higher numbers of CTPAs have lower diagnostic yields.
PURPOSE: To describe the inter-physician variability in the utilisation rate and diagnostic yield of computed tomography pulmonary angiography (CTPA) among a group of emergency department (ED) physicians working in a similar clinical environment. METHODS: We collected data on all CTPA studies ordered by ED physicians at three affiliated sites during a 2-year period between January 1, 2016, and December 31, 2017. For each physician, we calculated individual CTPA utilisation rate (total number of CTPAs ordered per 1000 ED visits) and diagnostic yield (percentage of CTPAs that were positive for PE). Additional analysis was carried out in order to identify the highest orderers of CTPA and their diagnostic yield. RESULTS: Seventy-seven ED physicians who collectively ordered a total of 2788 CTPAs were included in the study. Utilisation rates ranged from 1.1 to 22.2 CTPA per 1000 ED visits (median: 5.2 CTPA/1000 ED visits; 25%ile: 3.6 CTPA/1000 ED visits; 75%ile: 7.9 CTPA/1000 ED visits) and the CTPA diagnostic yields ranged from 0% to 33% (median: 9.1%; 25%ile: 5.2%; 75%ile: 16.1%). Those physicians in the lower quartile for ordering rate had a higher mean diagnostic yield when compared to the higher quartiles. CONCLUSION: The findings of this study demonstrate variability in CTPA ordering patterns and diagnostic yields among physicians working within the same clinical environment. There is some suggestion that those physicians who order disproportionately higher numbers of CTPAs have lower diagnostic yields.
Authors: Dana R Kindermann; Melissa L McCarthy; Ru Ding; William J Frohna; Jonathan Hansen; Kevin Maloy; David P Milzman; Jesse M Pines Journal: J Emerg Med Date: 2014-03-11 Impact factor: 1.484
Authors: Arjun K Venkatesh; Leila Agha; Jason Abaluck; Craig Rothenberg; Christopher Kabrhel; Ali S Raja Journal: AJR Am J Roentgenol Date: 2018-01-24 Impact factor: 3.959
Authors: Ian Buchanan; Troy Teeples; Margaret Carlson; Jacob Steenblik; Joseph Bledsoe; Troy Madsen Journal: Acad Emerg Med Date: 2017-09-19 Impact factor: 3.451
Authors: Rebecca Smith-Bindman; Diana L Miglioretti; Eric Johnson; Choonsik Lee; Heather Spencer Feigelson; Michael Flynn; Robert T Greenlee; Randell L Kruger; Mark C Hornbrook; Douglas Roblin; Leif I Solberg; Nicholas Vanneman; Sheila Weinmann; Andrew E Williams Journal: JAMA Date: 2012-06-13 Impact factor: 56.272
Authors: Aanchal Agarwal; Jennifer Persaud; Rafal Grabinski; Dean Rabinowitz; Alexandra Bremner; Richard Mendelson Journal: J Med Imaging Radiat Oncol Date: 2012-04-11 Impact factor: 1.735
Authors: C W Ong; V Malipatil; M Lavercombe; K G W Teo; P B Coughlin; D Leach; M C Spanger; F Thien Journal: Intern Med J Date: 2013-02 Impact factor: 2.048