Table 3.

Success Stories from Top-Performing ED Sites

ATRAUMATIC LOW BACK PAIN	“Our challenge was educating the staff that not all patients with back pain need imaging. Also, obtaining good data was and remains a challenge. Finally, it can be challenging to get providers to change their practice patterns and it can be difficult, even in the age of the EMR to get reliable data. We believe we were able to reduce the utilization of imaging in patients with atraumatic back pain. If we were to do this project over again, I believe that it would have been easier if we worked with IT to generate baseline data and then provide post- education data.” - ED Medical Director (Large Volume, Urban ED)
SYNCOPE	“The biggest challenge was changing practice behaviors in those who have been practicing for many years and are used to doing [things] a certain way. Another challenge is that they may not have kept up with the current literature on this topic. We were able to change ordering patterns in our clinicians with respect to this category of patients. In the moment, discussions as well as radiology decision support helped move the needle on this. Continued reminders and frequent re-education is necessary to change practice. If we were going to do this project over again, we would implement more frequent updates.” - ED Residency Program Director (Medium Volume, Urban ED)
MINOR HEAD INJURY	“Our challenge at first was educating staff (docs and nurses) that not necessarily all patients with head injury need CT. Our baseline numbers were actually better than I expected, and department-wide education was well-received. If we were going to do this project over again, we would have reading material for patients at the outset, perhaps to read as they are waiting for a provider.” - ED Medical Director (Small Volume, Rural ED) “Our group learned that instituting a validated clinical decision rule such as the Canadian Head CT Rule successfully decreased our imaging rates and increased our diagnostic yield. By knowing and having the literature to support our decisions, we were able to engage patients and their families in discussions about imaging and it’s risks and successfully avoid imaging in patients that expected to have a head CT after their minor head injury. If we were going to do this project over again, we would present our project and goals at the resident didactic conference in order to address as many residents as possible. With several residents rotating through the ED each month, it was difficult to discuss this initiative with them individually. In addition, a patient simulation of a difficult patient demanding CT imaging in a role play situation may be a tool that would aid in providers being able to manage patient expectations.” - ED Physician (Medium Volume, Urban ED)