The impact of ordering provider specialty on appropriateness classification.

BACKGROUND: There is limited published data comparing the appropriateness use criteria for SPECT MPI with the specialty of the ordering provider. The aim of this study was to examine if the specialty of the ordering provider affected either the ordering indication or the appropriateness of stress SPECT MPI. METHODS AND RESULTS: The ordering provider's specialty was compared with the study indication and appropriateness rating. There were modest but significant differences in general indications by specialty. For example, the Emergency Department group ordered fewer studies in asymptomatic patients (3% compared to 14%-23% in the other four referral groups). In contrast, 43% of the studies ordered by Cardiovascular Division physicians and 39% of the studies ordered by the Registered Nurse group were on post-revascularization patients, compared to 23%-31% of those ordered by the other three groups. Overall appropriateness classification did not differ among the five specialty groups (P 5 0.19). CONCLUSION: In a clinical practice where pre-operative testing using SPECT is infrequent,the rate of inappropriate studies was similar for all ordering providers. Quality improvement efforts in similar practices will likely require a broad educational focus on all ordering providers.

The timing and impact of follow-up studies after normal stress single-photon emission computed tomography sestamibi studies.

BACKGROUND: The purpose of this study was to determine the prevalence and timing of routine follow-up single-photon emission computed tomography (SPECT) studies after a normal stress SPECT scan compared with the patient's warranty period (ie, time to 1% risk of death or myocardial infarction). METHODS AND RESULTS: We identified patients at Mayo Clinic Rochester who had normal stress SPECT scans in 2002. Of 2354 patients without prior coronary artery disease, 309 (13%) had routine follow-up scans. The time to routine follow-up was a median of 2.1 years (25th percentile, 1.2 years; 75th percentile, 3.6 years). This interval was a median of 45% of the warranty period. Of the 309 patients, only 9 (3%) underwent subsequent coronary angiography, without revascularization. Of 656 patients with prior coronary artery disease, 171 (26%) had routine follow-up scans. The time to routine follow-up was a median of 1.6 years (25th percentile, 1.0 years; 75th percentile, 2.7 years). This interval was a median of 164% of the warranty period. Of the 171 patients, only 7 (4%) underwent coronary angiography, without revascularization. CONCLUSIONS: In patients without prior coronary artery disease, routine follow-up SPECT scans are performed infrequently but well before the end of the patient's warranty period. Routine follow-up scans are performed more commonly in patients with prior coronary artery disease but generally after the end of the warranty period. Routine follow-up SPECT scans have minimal impact on referral to catheterization or revascularization.