Awareness of relative CT utilization among peers is not associated with changes in imaging requests among emergency department providers in a large county hospital

Purpose: The purpose of this quality improvement initiative was to study the effect of providing scorecards to emergency department providers to assess its effect on changes in utilization. Methods: CT of the abdomen and pelvis, CT angiogram of the chest for pulmonary embolism, and CT of the head were targeted due to ordering variability, cost, and radiation exposure. The utilization rate for each provider was assessed for emergency department providers. Following this, providers were given scorecards regarding their utilization as well as their relative utilization compared with each other. Utilization was then monitored following the intervention to assess the effect of the scorecard on ordering practices. Results: No significant effect on the utilization of these 3 exams was found after the scorecard intervention. Conclusion: Providing scorecards to make emergency department providers aware of their relative utilization does not significantly alter ordering behavior. Incentive-based systems may be required in order to lessen overutilization of these 3 commonly ordered radiology procedures in the emergency department.