(1266) Can a Hospital-Wide Educational Effort Impact Diagnostic Practice Patterns in Suspected PE?

Introduction: Diagnostic work up of Pulmonary Embolism (PE) often lacks standardization leading to overutilization of imaging, overdiagnosis, and unnecessary cost. The validated clinical decision rule, the Wells Criteria, can be utilized with an age-adjusted D-dimer strategy to reduce imaging in patients who are unlikely to have PE. Despite this, adoption of a risk-based approach to PE workup remains challenging. The purpose of our study was to determine if a hospital wide educational effort would improve compliance with risk-based PE work up and reduce CT Pulmonary Angiography (CTPa) imaging in low-risk patients.

Methods: Through a multidisciplinary PE committee at our community hospital, we developed an evidence-based guideline for PE workup and management which was approved by the medical executive committee. This was followed by educational interventions to standardize practice including grand rounds presentations, educational flyers, and a mobile friendly website. Further reinforcement occurred via department meetings and random provider audits. To assess success, we performed a retrospective chart review. We analyzed all CTPa exams ordered in the six months pre and post our educational intervention’s launch. Patient charts were grouped by Wells score >4 and ≤4. D-dimer utilization rates, protocol-based CTA utilization rates, and observed PE rates were calculated, and Pearson's chi-squared analysis assessed clinical significance.

Results: 1009 patients had a CTPa for suspected PE (pre=501; post=508) and 200 patients were randomly selected from each group for analysis. In both groups, the % of patients with Wells score ≤4 was similar (79.0% vs 79.5%). No clinically significant pre and post intervention differences were observed in: D-dimer utilization Wells ≤4 (32.9% vs 32.1%, p=0.87); protocol based CTPa utilization (59.0% vs 57.0%, p=0.69); observed PE rate (7.5% vs 7.5%, p=1.0).

Conclusions: Creation of a hospital-wide multidisciplinary PE guideline followed by a multipronged educational effort did not have a statistically significant impact on D-dimer utilization, appropriate risk-based CTPa utilization, or PE accuracy. Secondary data analysis is currently underway to determine if these interventions had an impact on PE management.