Highlights
- •Survey data from a large national sample of volunteer hospital-based EDs shows wide variation in imaging utilization
- •ED sites with sustained participation in a national QI initiative showed significant reductions in imaging utilization
- •Imaging utilization rates from top-performing ED sites can serve as performance improvement targets for future QI efforts
- •Efforts to translate the Choosing Wisely campaign into practice should utilize benchmarking to sustain practice improvements
Abstract
Purpose
To characterize performance among ED sites participating in the Emergency Quality
Network (E-QUAL) Avoidable Imaging Initiative for clinical targets on the American
College of Emergency Physicians Choosing Wisely list.
Methods
This was an observational study of quality improvement (QI) data collected from hospital-based
ED sites in 2017–2018. Participating EDs reported imaging utilization rates (UR) and
common QI practices for three Choosing Wisely targets: Atraumatic Low Back Pain, Syncope,
or Minor Head Injury.
Results
305 ED sites participated in the initiative. Among all ED sites, the mean imaging
UR for Atraumatic Low Back Pain was 34.7% (IQR 26.3%–42.6%) for XR, 19.1% (IQR 11.4%–24.9%)
for CT, and 0.09% (IQR 0%–0.9%) for MRI. The mean CT UR for Syncope was 50.0% (IQR
38.0%–61.4%). The mean CT UR for Minor Head Injury was 72.6% (IQR 65.6%–81.7%). ED
sites with sustained participation showed significant decreases in CT UR in 2017 compared
to 2018 for Syncope (56.4% vs 48.0%; 95% CI: −12.7%, −4.1%) and Minor Head Injury
(76.3% vs 72.1%; 95% CI: −7.3%, −1.1%). There was no significant change in imaging
UR for Atraumatic Back Pain for XR (36.0% vs 33.3%; 95% CI: −5.9%, −0;5%), CT (20.1%
vs 17.7%; 95% CI: −5.1%, −0.4%) or MRI (0.8% vs 0.7%, 95% CI: −0.4%, −0.3%).
Conclusions
Early data from the E-QUAL Avoidable Imaging Initiative suggests QI interventions
could potentially improve imaging stewardship and reduce low-value care. Further efforts
to translate the Choosing Wisely recommendations into practice should promote data-driven
benchmarking and learning collaboratives to achieve sustained practice improvement.
Abbreviations:
E-QUAL (The Emergency Quality Network), QI (Quality Improvement)Keywords
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Article Info
Publication History
Published online: January 17, 2020
Accepted:
January 16,
2020
Received in revised form:
January 15,
2020
Received:
October 15,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
