Impact of a multi-modal intervention on CTA ordering rates in patients presenting with vertigo to the emergency department.

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Vertigo and dizziness are common complaints at emergency departments (ED), often leading to computed tomography (CT) and CT angiography (CTA) studies, which when used non-selectively, have low clinical utility. The study assesses whether two quality improvement interventions (educational rounds and clinical decision making support tool) can better align CTA ordering rates with clinical practice guidelines in the ED workup of vertigo/dizziness at a large community hospital. CTA head and neck imaging rates were collected for patients presenting to the hospital's ED with dizziness/vertigo as the chief complaint during 6-month pre- and post-intervention periods and compared rates using the Chi-Square Test. The interventions were joint ED/Diagnostic Imaging/Stroke Neurology rounds discussing CTA head/neck indications and dissemination of a clinical decision making support tool. The absolute reduction was 5.79% (N = 4,230, p < 0.001) in CTA rates for patients presenting with dizziness/vertigo between the pre- and post-intervention periods. For vertigo, the absolute reduction was 12.27% (N = 402, p < 0.005). For dizziness, the absolute reduction was 5.17% (N = 3828, p < 0.001). Despite the global decrease in CTA studies, there was no statistically significant decrease in CTA rates for the patients who were diagnosed with cerebrovascular accident or transient ischemic attack in the ED, indicating that the interventions were effective in limiting to the targeted CTA studies. This project was effective in improving patient safety and system efficiency, while providing a framework for low-burden, effective, practice-modifying quality improvement initiatives.