Impact of a Clinical Decision Support System on Computed Tomographic Pulmonary Angiogram Yield and Utilization in Hospitalized Patients

Amita Sharma; Mark Isabelle; Andetta Hunsaker; Sayon Dutta; David Lucier; Rachel P Rosovsky; Sanjay Saini; Adam Landman; Ali S Raja; Ramin Khorasani; Ronilda Lacson

doi:10.1016/j.jacr.2024.11.030

Impact of a Clinical Decision Support System on Computed Tomographic Pulmonary Angiogram Yield and Utilization in Hospitalized Patients

J Am Coll Radiol. 2024 Dec 9:S1546-1440(24)00947-5. doi: 10.1016/j.jacr.2024.11.030. Online ahead of print.

Authors

Amita Sharma¹, Mark Isabelle², Andetta Hunsaker³, Sayon Dutta⁴, David Lucier⁵, Rachel P Rosovsky⁶, Sanjay Saini¹, Adam Landman⁷, Ali S Raja⁸, Ramin Khorasani⁹, Ronilda Lacson¹⁰

Affiliations

¹ Department of Radiology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
² Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA.
³ Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
⁴ Harvard Medical School, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
⁵ Harvard Medical School, Boston, MA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.
⁶ Harvard Medical School, Boston, MA; Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
⁷ Harvard Medical School, Boston, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.
⁸ Harvard Medical School, Boston, MA; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
⁹ Harvard Medical School, Boston, MA; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA.
¹⁰ Harvard Medical School, Boston, MA; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA. Electronic address: rlacson@bwh.harvard.edu.

PMID: 39662713
DOI: 10.1016/j.jacr.2024.11.030

Abstract

Objective: To determine whether point-of-order clinical decision support (CDS) based on the Wells Criteria improves CT pulmonary angiogram (CTPA) yield and utilization in hospitalized patients in an enterprise-wide health system and identify yield-related factors.

Methods: This retrospective IRB-approved cross-sectional study in an urban, multi-institution health system included hospitalized patients undergoing CTPA 12 months before and after CDS implementation (entire cohort). Chi-square test was used to compare PE yield in patients in whom providers overrode vs. followed CDS alerts after CDS implementation. It was also used to compare utilization and yield pre- vs. post-intervention. Univariate and multivariable regression analyses were performed on patient factors and post-CDS Wells scores to evaluate yield-related factors.

Results: For 2,429 inpatient CTPAs post-intervention, CTPA yield was significantly higher when CDS recommendations were followed (18.3% [250/1365]) compared to those overridden (14.2% [151/1064] (p<0.01). For 5,372 CTPAs in the entire cohort, there was no difference in PE yield before (448/2,943; 15.2%) vs. after (401/2,429; 16.5%) CDS implementation (p=0.20). However, in 340,146 admissions over the study period, a 7.4% relative decrease in CTPA utilization (17.5 to 16.2 CTPA examinations/1000 admissions before and after CDS, respectively; p=0.003) was observed.

Discussion: When CDS recommendations were followed, the yield of CTPA was significantly higher than when clinicians overrode CDS alerts. In addition, point-of-order CDS to reduce unnecessary CTPA in hospitalized patients resulted in a significant decrease in CTPA utilization post-CDS implementation with a modest though nonsignificant increase in CTPA yield.