Choosing wisely in emergency medicine: Early results and insights from the ACEP emergency quality network (E-QUAL).
Am J Emerg Med
; 39: 102-108, 2021 01.
Article
em En
| MEDLINE
| ID: mdl-32014376
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Diagnóstico por Imagem
/
Procedimentos Desnecessários
/
Benchmarking
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Serviço Hospitalar de Emergência
/
Melhoria de Qualidade
Tipo de estudo:
Diagnostic_studies
/
Guideline
/
Observational_studies
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article