375 Comparison of Electronic Clinical Decision Support for the Diagnosis of Suspected Pulmonary Embolism in Three Health Care Systems

Abstract

Clinical decision support (CDS) for the diagnosis of acute pulmonary embolism (PE) has been recommended by multiple professional societies, yet its use remains uncommon. We sought to compare the CTPA positive rate at 4 hospitals where electronic CDS is optional, 1 hospital where eCDS was mandatory, and 1 hospital where eCDS was not available. We performed a retrospective cohort study at 6 hospital emergency departments (EDs), 3 academic level 1 trauma centers and 3 large suburban community hospitals with combined visits of 286,096 from January-December 2016. Included patients were age >17, with suspected PE determined by the treating emergency physician. Patients were excluded if age <18, or pregnant at the time of enrollment. eCDS consisted of PE Rule-out Criteria (PERC), Revised Geneva Score (RGS) or Wells score followed by age-adjusted d-dimer when appropriate and was implemented in 5 hospitals electronic medical record; 4 where the use of eCDS was optional and 1 where it was mandatory prior to ordering CTPA. We compared the relative risk and percent relative risk of having a positive CTPA using combined eCDS utilization data from the mandatory use hospital plus the cases where eCDS was used at the 4 optional use hospitals, to the hospital where eCDS was not available and cases where eCDS was not utilized at the optional hospitals. At the 5 hospitals with eCDS available 1147 CTPA’s were performed using the eCDS tools with 184 PE diagnoses for a CTPA positive rate of 16% (95% CI: 14-18%). At the hospitals where eCDS was not used or not available, 4560 CTPA were performed with 302 PE’s diagnosed for a CTPA positive rate of 6.6% (95% CI: 5.9-7.4%). With eCDS use, relative risk of having a positive CTPA is 2.42 (95% CI: 2.04-2.88; p<0.001), compared to no use of eCDS. Percent relative risk shows CTPA’s are 142% more likely to be positive with eCDS utilization. eCDS utilization is associated with a higher CTPA positive rate.Tabled 1CTPA positive rate with eCDSCTPAN=PE Diagnoses N=% Positive (95% CI)eCDS114718416% (14.1-18.3)No eCDS45603026.6% (5.9-7.4) Open table in a new tab