To review quality and safety awareness by assessing appropriate CTPA utilisation in a metropolitan Emergency Department. To go beyond and educate Radiologistabout the safe use of CTPA so requests can be appropriately protocoled.

It is the Radiologist's responsibility to ensure each CTPA request is justified and necessary for best patient outcome, patient safety and resource allocation. Literature estimates a 15% positive CTPA rate correlates with correct use of imaging(1). This clinical audit reviewed one month of CTPA’s performed at a major metropolitan hospital reviewing positive rate and if validated CTPA indications had been used and documented. To assist physicians appropriately using CTPA, the PAH created a specific CTPA request form. This involves a flow chart prompting doctors to...

97 CTPA's were assessed. The positive rate of CTPA was 8%, below the recommended 15%. No requests had used the specific CTPA request form. 46% of performed CTPA's should have had further work up before imaging was considered. Only 19 patients (19%) had a Wells' score documented (Table 1). 7 patients had a Wells' under 2 and, of these, 2 patients did not have a PERC documented (Table 2). All of these 7 patients received an inappropriately ordered D-dimer, all of which were positive. All...

This audit shows that potentially 45 inappropriate CTPA's were performed in one month. This puts 45 patients per month at risk of CTPA complications and placesunnecessarystrain on the Radiology department. Overutilisation of CTPA’s was due to either underuse or disregarding the risk assessment tools. Inappropriate CTPA’s would be reduced if validated clinical decision making tools, like Wells' and PERC, had been utilised. 80% of CTPAs had no documentation of a Wells' score to guide investigation and 4% actually had documented a negative D-dimer. At the...

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