• Am J Emerg Med · Jan 2021

    Observational Study

    Choosing wisely in emergency medicine: Early results and insights from the ACEP emergency quality network (E-QUAL).

    • Arjun K Venkatesh, Jean Elizabeth Scofi, Craig Rothenberg, Carl T Berdahl, Nalani Tarrant, Dhruv Sharma, Pawan Goyal, Randy Pilgrim, Kevin Klauer, and Jeremiah D Schuur.
    • Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States of America; Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT, United States of America. Electronic address: arjun.venkatesh@yale.edu.
    • Am J Emerg Med. 2021 Jan 1; 39: 102-108.

    PurposeTo 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.MethodsThis 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.Results305 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%).ConclusionsEarly 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.Copyright © 2020 Elsevier Inc. All rights reserved.

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