363 Electronic Decision Support for Suspected Pulmonary Embolism: Electronic Pulmonary Embolism in Two Health Care Systems

Abstract

To evaluate the effectiveness of electronic clinical decision support on the diagnostic yield of CT pulmonary angiography for suspected pulmonary embolism (PE). Electronic decision support tools for suspected PE integrating PE Rule-out Criteria, Revised Geneva Score, and age-adjusted d-dimer prior to imaging, was implemented in the electronic health record of two health care systems hospitals each with >80,000 patients/year, 1 Epic site and 1 Cerner site. CT pulmonary angiography diagnostic yield and overall CTPA rates were evaluated and compared to matched controls. 95,382 patients were evaluated, with 53% female and mean age of 39. Prior to ePE tool availability 1.8% of all patients underwent CTPA compared to 1.9% with use of the ePE tool. CTPA yield was 11.3% at the Epic site and 11.2% at the Cerner site before and 14.6% and 15.6% after the ePE tool availability, respectively, representing an improvement by 3.3% (95% CI= 2.16-4.32, p<0.001) at the Epic site and at the Cerner site 4.4% (95% CI= 3.06-5.24, p<0.001). CTPA ordering rates were not significantly changed with ePE tool implementation, but CTPA yield improved with use of an electronic decision support for PE diagnosis.