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Conference Highlights: ACEP16

Conference Highlights: ACEP16

Clinical Decision Support Reduces High-Cost Imaging Prior research has shown that brain, cervical spine, and pulmonary embolism CT scans are overutilized, low-value diagnostics tests in the ED. For a study, researchers evaluated the impact of evidence-based clinical decision support (CDS) that was integrated into physician electronic health record workflow on overall use and physician-level variability in the use of these three tests. Physicians attempting to order one of the CT tests were met with an alert, led to the appropriate clinical decision rule, and made aware if their order was indicated. Justification could be given to override the alert. Following implementation of the CDS tool, CT brain and cervical spine scans decreased by 10% and 6%, respectively. Pulmonary embolism scan use did not change significantly overall. However, pulmonary embolism scan use decreased 13% for high utilizers at the start of the study, remained unchanged for average users, and increased 40% for low users. A similar pattern was seen for cervical spine scans. —————————————————————-   Nursing Hours & ED Throughput Metrics Patient length of stay (LOS) in the ED remains an important measurable factor in evaluating performance. However, data are lacking on the impact of ED nursing hours on ED LOS and the number of patients who leave without being seen (LWBS) by a provider. For a study involving more than 100,000 ED visits during 2015, researchers recorded daily ED LOS, ED patient volume, the number of patients who LWBS each day, and daily nursing hours. After controlling for daily ED volume and hospital occupancy, the authors found that days with below median nursing hours led to 19.7-minute longer door-to-discharge...
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