AUA QI Summit 2017: National Quality Initiatives in Renal Colic Imaging from the American College of Emergency Physicians (ACEP)

Linthicum, Maryland ( Dr. Arjun Venkatesh, an emergency medicine physician from Yale University, provided an excellent presentation discussing the national quality initiatives in renal colic imaging from the American College of Emergency Physicians (ACEP), noting that reducing avoidable abdominal CT imaging for renal colic in low-risk patients is one of the initiatives of ACEP’s Choosing Wisely campaign. This initiative is primarily run by the Emergency Quality Network (E-QUAL), a platform under the ACEP umbrella. E-QUAL has seen tremendous increases in physician recruitment, going from ~5,000 physicians in January 2016 to 27,464 emergency medicine physicians in July 2017 at 863 emergency department sites in the US.

E-QUAL sites have several responsibilities:

1. Recruitment and Enrollment
    a. Readiness assessment survey
    b. Participation sign-up

2. Learning Period (9 months)
    a. Monthly webinars
    b. Introduction to the tool kit
    c. Publicize guidelines and materials
    d. Disseminate CME
    e. Provide benchmarking data

3. Wrap-Up
    a. Data reports
    b. Summary reports
    c. Lessons learned
    d. eCME credit
    e. Re-enrollment

Dr. Venkatesh highlights that there is substantial work to be done regarding emergency department avoidance of CT scanning of the abdomen/pelvis in patients with recurrent renal colic. As of their most recent census, only 17% of sites are currently engaged in quality improvement (QI) activities to reduce CT imaging for recurrent renal colic. However, the encouraging statistic is that 48% are interested in starting this QI initiative. The QI approaches used thus far for reducing imaging in this arena have included provider-specific feedback reports on imaging utilization or appropriateness (33%), computerized decision support (14%), and radiologist review or consultation for imaging (32%). In a pilot benchmarking assessment for CT utilization rates of CT imaging for renal colic, there is considerable variation in CT utilization from 9%-31%. An exciting initiative is the Clinical Emergency Data Registry (CEDR), a registry designed to centralize data. This is a CMS designated qualified clinical data registry designed to measure healthcare quality, outcomes, practice patterns, and trends in emergency care. Additionally, CEDR was developed by ACEP to enable emergency physician participation in MACRA and is the first and only emergency medicine specialty at a national level.

There are several CEDR metrics that will be part of their next steps, including (i) Measure testing: Are EHR codes valid? Is the measure reliable at the provider or group level? (ii) Unanswered questions: Should low-dose CT be included? and (iii) Future initiatives: Complementary measures in the non-emergency department settings.

Speaker: Arjun Venkatesh, Yale University, New Haven, CT, USA

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md, at the AUA Quality Improvement Summit - October 21, 2017- Linthicum, Maryland