{"pk":10348,"title":"Choosing Wisely Imaging Recommendations: Initial Implementation in New England Emergency Departments","subtitle":null,"abstract":"Introduction\n \nIn June 2016, the American College of Emergency Physicians (ACEP) Emergency Quality Network began its \nReduce Avoidable Imaging Initiative\n, designed to “reduce testing and imaging with low risk patients through the implementation of \nChoosing Wisely r\necommendations”. However, it is unknown whether New England Emergency Departments (EDs) have already implemented evidence-based interventions to improve adherence to ACEP\n Choosing Wisely\n recommendations related to imaging after their initial release in 2013.  Our objective was to determine this, as well as whether provider-specific audit-and-feedback for imaging had been implemented in these EDs.\n \n \nMethods\n \nThis survey study was exempt from Institutional Review Board review. In 2015, we mailed surveys to 195 hospital-affiliated EDs in all six New England states to determine whether they had implemented \nChoosing Wisely\n-focused interventions in 2014. Initial mailings included cover letters denoting the endorsement of each state’s ACEP chapter, and were followed-up twice with repeat mailings to non-responders. Data analysis included descriptive statistics and a comparison of state differences using Fisher’s exact test.\n \n \n \nResults\n \nA total of 169/195 (87%) of New England EDs responded, with all individual state response rates >80%. Overall, 101 (60%) of responding EDs had implemented an intervention for at least one \nChoosing Wisely\n imaging scenario; 57% reported implementing a specific guideline/policy/clinical pathway, 40% had implemented provider-specific audit-and-feedback, and 28% reported implementing a computerized decision support system. The most common interventions were for chest CT in patients at low-risk of pulmonary embolism (47% of EDs) and head CT in patients with minor trauma (45% of EDs). In addition, 40% of EDs had implemented provider-specific audit-and-feedback, without significant interstate variation (range: 29-55%).\n \n \n \nConclusion\n \nOne year after release of the ACEP \nChoosing \nWisely recommendations, most New England EDs had a guideline/policy/clinical pathway related to at least one of the recommendations. However, only a minority were using provider-specific audit-and-feedback or computerized decision support. Few EDs have embraced the opportunity to implement the multiple evidence-based interventions likely to advance the national goals of improving patient-centered and resource-efficient care.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Emergency Medicine"},{"word":"Emergency Radiology"},{"word":"Quality Improvement"}],"section":"Patient Safety","is_remote":true,"remote_url":"https://escholarship.org/uc/item/70977873","frozenauthors":[{"first_name":"Ali","middle_name":"S.","last_name":"Raja","name_suffix":"","institution":"Department of Emergency Medicine\nMassachusetts General Hospital\nHarvard Medical School","department":"None"},{"first_name":"Arjun","middle_name":"K.","last_name":"Venkatesh","name_suffix":"","institution":"Department of Emergency Medicine and \nCenter for Outcomes Research and Evaluation\nYale University School of Medicine","department":"None"},{"first_name":"Nathan","middle_name":"","last_name":"Mick","name_suffix":"","institution":"Department of Emergency Medicine, Maine Medical Center\nTufts University School of Medicine","department":"None"},{"first_name":"Christopher","middle_name":"","last_name":"Zabbo","name_suffix":"","institution":"Department of Emergency Medicine\nKent Hospital, Warwick, RI","department":"None"},{"first_name":"Kohei","middle_name":"","last_name":"Hasegawa","name_suffix":"","institution":"Department of Emergency Medicine\nMassachusetts General Hospital\nHarvard Medical School","department":"None"},{"first_name":"Janice","middle_name":"","last_name":"Espinola","name_suffix":"","institution":"Department of Emergency Medicine\nMassachusetts General Hospital","department":"None"},{"first_name":"Jane","middle_name":"","last_name":"Bittner","name_suffix":"","institution":"Department of Emergency Medicine\nMassachusetts General Hospital","department":"None"},{"first_name":"Carlos","middle_name":"A","last_name":"Camargo","name_suffix":"","institution":"Department of Emergency Medicine\nMassachusetts General Hospital\nHarvard Medical School","department":"None"}],"date_submitted":"2016-09-28T11:40:55-04:00","date_accepted":"2016-09-28T11:40:55-04:00","date_published":"2017-03-08T13:26:27-05:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/10348/galley/5689/download/"}]}