It is critical that emergency physicians are able to use and understand the data on diagnostic testing in their department and have comparison data available for their peers. This will allow better decision making by all parties involved in utilization management.
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ACEP Now: Vol 34 – No 04 – April 2015
James J. Augustine, MD, FACEP, is director of clinical operations at EMP in Canton, Ohio; clinical associate professor of Emergency Medicine at Wright State University in Dayton, Ohio; vice president of the Emergency Department Benchmarking Alliance; and on the ACEP Board of Directors.
Dr. Broida, is director of risk management for Emergency Medicine Physicians (EMP) in Canton, Ohio; is COO of EMP’s medical malpractice insurance company; and serves on the ACEP Medical Legal and EM Practice committees.
References
- Arasu VH. Diagnostic emergency imaging utilization at an academic trauma center from 1996 to 2012. J Am Coll Radiol. 2015 Jan 23. [Epub ahead of print]
- The Emergency Department Benchmarking Alliance. Available at: www.EDBenchmarking.org.
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2 Responses to “Diagnostic Testing Usage Data Can Help Emergency Physicians Manage Utilization”
June 12, 2015
henry richterDrs. Augustine and Broida:
REF: “The ED diagnostic Center”, ACEP NOW April 2015
Your article brings up an interesting though subtle issue. Particularly focusing on soft tissues imaging ( US, CT, MRI), many of these tests are normal. The quick response is to bemoan the these normals as ” over-utilization”. However, the normals are of immense utility if used in the following manner.
Please be aware I am not an academic and these observations are based on a 36 yr medical career, half spent in ED care, and half in primary care.
Every normal test is predictive of remaining normal for a period of time. This infers that repeating the test will be de-facto over-utilization. The issue then is how long is this period of time? How much can this time interval be generalized to a population? How much of this time interval is specific to a single patient?
Let me give examples. A normal biliary ultrasound will remain normal, in the sense of the diseases of ED interest, for years. Two years at least, approaching five years in a younger cohort. A normal CT pulmonary angiogram essentially rules out any consideration of PE close to forever. Any PE that occurs in the years after a normal test must then immediately provoke a search for an underlying cause. A normal CT abd/pelvis is good for at least a year.
Of course clinical acumen is available, at any time, to over rule these generalizations. Cancer changes everything.
The statistics in your article do not educate me any any useful way. So what is my basic thought. However, I am presenting you with an opportunity to delve into barren numbers and attempt to find a teachable moment for providers. Will you design a study to track the stability of patients given certain imaging results? As our profession moves into the era of ACOs, the issues increases in importance.
Henry Richter MD
July 20, 2015
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