The impact of an electronic clinical decision support for pulmonary embolism imaging on the efficiency of computed tomography pulmonary angiography utilisation in a resource-limited setting

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dc.contributor.authorMurthy, C.en_ZA
dc.contributor.authorDavis, R.en_ZA
dc.contributor.authorKoegelenberg, C. F. N.en_ZA
dc.contributor.authorIrusen, E. M.en_ZA
dc.contributor.authorPitcher, R. D.en_ZA
dc.date.accessioned2017-02-10T06:48:25Z
dc.date.available2017-02-10T06:48:25Z
dc.date.issued2016-01
dc.descriptionCITATION: Murthy, C. et al. 2016. The impact of an electronic clinical decision support for pulmonary embolism imaging on the efficiency of computed tomography pulmonary angiography utilisation in a resource-limited setting. South African Medical Journal, 106(1):62-64, doi:10.7196/SAMJ.2016.v106i1.9886.
dc.descriptionThe original publication is available at http://www.samj.org.za
dc.description.abstractENGLISH SUMMARY : Background. Pulmonary embolism (PE) is associated with high morbidity and mortality. Effective intervention requires prompt diagnosis. Computed tomography pulmonary angiography (CTPA) is sensitive and specific for PE and is the investigation of choice. Inappropriate CTPA utilisation results in unnecessary high radiation exposure and is costly. State­of­the­art electronic radiology workflow can provide clinical decision support (CDS) for specialised imaging requests, but there has been limited work on the clinical impact of CDS in PE, particularly in resource­constrained environments. Objective. To determine the impact of an electronic CDS for PE on the efficiency of CTPA utilisation in a resource­limited setting. Methods. In preparation, a PE diagnostic algorithm was distributed to hospital clinicians, explaining the combined role of the validated modified Wells score and the quantitative D­dimer test in defining the pre­test probability of PE. Thereafter, an automated, electronic CDS was introduced for all CTPA requests. Total CTPA referrals and the proportion positive for PE were assessed for three study phases: (i) pre­ diagnostic algorithm; (ii) post­algorithm, pre­CDS; and (iii) post­CDS. Results. The proportion of CTPAs positive for PE after CDS implementation was almost double that prior to introduction of the diagnostic algorithm (phase 1 v. 3, 17.4% v. 30.7%; p=0.036), with a correspondingly significant decrease in the proportion of non­positive CTPAs (phases 1 v. 3, 82.6% v. 69.3%; p=0.015) During phases 2 and 3, no CTPAs were requested for patients with a modified Wells score of ≤4 and a documented negative D­dimer, indicating adherence to the algorithm. Conclusion. Implementing an electronic CDS for PE significantly increased the efficiency of CTPA utilisation and significantly decreased the proportion of inappropriate scans.en_ZA
dc.description.urihttp://www.samj.org.za/index.php/samj/article/view/9886
dc.description.versionPublisher's version
dc.format.extent3 pages ; illustrations
dc.identifier.citationMurthy, C. et al. 2016. The impact of an electronic clinical decision support for pulmonary embolism imaging on the efficiency of computed tomography pulmonary angiography utilisation in a resource-limited setting. South African Medical Journal, 106(1):62-64, doi:10.7196/SAMJ.2016.v106i1.9886.
dc.identifier.issn2078-5135 (online)
dc.identifier.issn0256-9574 (print)
dc.identifier.otherdoi:10.7196/SAMJ.2016.v106i1.9886
dc.identifier.urihttp://hdl.handle.net/10019.1/100614
dc.language.isoen_ZAen_ZA
dc.publisherHealth & Medical Publishing Group
dc.rights.holderAuthors retain copyright
dc.subjectMedical radiologyen_ZA
dc.subjectDiagnostic imagingen_ZA
dc.subjectPulmonary embolismen_ZA
dc.subjectRespiratory system -- Tomographyen_ZA
dc.subjectAngiographyen_ZA
dc.titleThe impact of an electronic clinical decision support for pulmonary embolism imaging on the efficiency of computed tomography pulmonary angiography utilisation in a resource-limited settingen_ZA
dc.typeArticleen_ZA
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