Big-Picture Solutions to Over-Investigating

Some potential solutions to over-investigating include malpractice reform, more time spent talking to patients, and a change in the system of financial rewards for ordering tests. For PE workup in particular, departmental decision support systems have been shown to reduce imaging rates and increase diagnostic yield.¹⁷

So next time you’re about to pull the trigger on ordering a CTPA for suspected PE based on gestalt, instead take the time to use your evidence-based departmental decision support system that utilizes diagnostic decision tools such as Geneva score, Wells’ score, D-dimer and PERC rule. If your patient is young or has a contrast allergy, consider a V/Q SPECT as a potentially more accurate test for PE that may result in fewer false positives with less radiation than CTPA.

Special thanks to Dr. Eddy Lang and Dr. Kerstin de Wit for their expert contributions to the EM Cases podcast on which this article was based. 

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References

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