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Audit of computed tomography pulmonary angiogram (CTPA) requesting at Hammersmith hospital

Introduction CTPA is the gold standard for diagnosing pulmonary emboli (PE). CTPA is expensive and involves exposure to high levels of radiation. NICE provides detailed diagnostic pathways to follow when PE is suspected. This guidance involves using Well9s score to differentiate high risk patients in addition to a D-dimer test. Aims To determine the proportion of CTPA requests using a Well9s score or D-dimer in accordance with NICE guidance. Methods Retrospective data was collected for CTPA scans carried out from 1 st June to 31 st August 2013. The requests were examined and details of Well9s scores and D-dimers was extracted. The diagnostic result of each CTPA was recorded. After initial audit, posters detailing the Well9s score and NICE guidance were placed throughout the hospital. The audit results were presented at various regional meetings. The audit cycle was completed by collecting data from 1 st January to 31 st March 2014. Results 76 CTPAs were carried out over June and August 2013. Of these, 8 patients were diagnosed with PE, 3 had a Well9s score calculated, while 49 had a D-dimer. A range of other respiratory pathology was identified including consolidation and malignancy. Re-audit data from January 2014 demonstrated an increased number of Well9s scores being calculated. However, no increase in the number of PE diagnoses was observed. Conclusions It is obvious that NICE guidance on CTPA requesting is not being followed to a suitable standard. In addition, the positive yield of PE was only 10.5%. This may indicate the threshold for ordering CTPA is too low and patients are exposed to high doses of radiation unnecessarily. Finally, the results demonstrate inefficient use of funding and resources.