Decision Support Cuts CT Pulmonary Angiography Orders from ED

The use of clinical decision support in the emergency room cuts the need for CT pulmonary angiography for acute pulmonary embolism by 20 percent and boosts yield 69 percent, according to a study published online on Dec. 20 in the journal Radiology.

The study was led by Ali S. Raja, MD, of Brigham and Women’s Hospital in Boston. The team considered use and yield of CT pulmonary angiography in the Brigham and Women’s Hospital emergency department from Oct. 1, 2003 to Sept. 30, 2009. In August 2007, the hospital’s emergency department implemented a clinical decision support system, which gave the researchers an opportunity to compare CT pulmonary angiography use before and after the new system was in place.

Of the 338,230 ED patients in the six-year study period, 6,838, or 2 percent, underwent CT pulmonary angiography. CT pulmonary angiography use increased 82.1 percent in the years prior to CDS implementation, from 14.5 to 26.4 examinations per 1,000 patients between October 2003 and July 2007.

After the clinical decision support system arrived, CT pulmonary angiography use fell 20.1 percent - from 26.4 to 21.1 examinations per 1,000 patients - between August 2007 and September 2009. Overall, 10 percent of the CT pulmonary angiographic examinations performed during the six-year period were positive for pulmonary embolism; with the clinical decision support system, yield increased 69 percent, from 5.8 percent to 9.8 percent.

“Implementation of evidence-based CDS in the ED was associated with a significant decrease in use, and increase in yield, of CT pulmonary angiography for the evaluation of acute PE,” concluded Raja and colleagues.