Reducing low-value testing in the emergency department through cost-effective physician education and personalised audit and feedback scorecards

Abstract

Objectives: Delivery of low-value healthcare impacts patients, resources, and overall healthcare sustainability. In Canada, an estimated 30% of tests, treatments, and procedures are unnecessary. As primary decision-makers, physicians have a major influence on healthcare utilisation. Despite numerous approaches to reduce low-value testing, success has been limited. Audit and feedback strategies have demonstrated variable effects in changing physician practice and often do not consider resource requirements. The objective of this study is to evaluate a resource-effective approach to decrease low-value testing in the emergency department (ED) through online education and personalised audit and feedback scorecards for two common ED tests. Methods: A single-centre, prospective pre–post trial of 31 ED physician’s ordering rates of urine cultures and rib X-rays was conducted at an academic community hospital in Ottawa, Ontario. The study included educational interventions on appropriate ordering guidelines and personalised audit and feedback scorecards from 2019 to 2020. Results: There was a 36.9 and 81.6% relative reduction in urine culture and rib X-ray ordering, respectively, between the baseline intervention and the 12-month post-scorecard period (p < 0.01). The group dispersion in ordering rates during the post-scorecard period was smaller compared to the wide dispersion at baseline. The rate of return ED visits for both tests remained unchanged. Variable cost analysis demonstrated $53,300 in cost-savings from reduced testing rates during the study period. The total study cost was $15,000. Interpretation: The combination of online education and personalised audit and feedback scorecards may present a resource-effective approach to change physician practice and reduce low-value testing in the ED. Further studies are needed to examine this approach in other departments and clinical topics in Canada.