Carryer, Damita J.

The Impact of Ordering Provider Specialty on Appropriateness Classification In prior studies, our laboratory applied the ACCF/ASNC AUC for SPECT MPI to several cohorts of patients in Mayo Clinic Rochester. The purpose of this study was to re-examine our data to test the hypothesis that the specialty of the ordering provider affected the appropriateness. We compared the ordering providers specialty with appropriateness determined in prior studies. The study group consisted of 281 patients who underwent stress SPECT MPI studies in May 2005 and 282 patients in October 2006 (before any quality improvement initiatives were begun at Mayo). Appropriateness categories were assigned by 2 experienced nurses from the CV Research Studies Unit not affiliated with the nuclear laboratory. Patients who were studied for pre-operative evaluation (n = 20) or post myocardial infarction (n = 7) were excluded because they comprised less than 5 percent of the patients. Pre-operative testing in our institution is done primarily by stress echocardiography. The final study group consisted of 526 patients. Excluding the 64 unclassified patients, AUE categories were appropriate (75 %), uncertain (13 %), inappropriate (12%). Results by ordering provider are shown in the figure, where CV = Cardiovascular MDs, ED = Emergency Department MDs, IM = General and Internal Medicine MDs, RN = Registered Nurses, and SP = other Specialty MDs. There was no significant association (p = 0.19); Chi-square analysis between appropriateness and specialty groups. In a clinical practice where pre-operative testing using SPECT is infrequent, the rate of inappropriate studies was similar for all ordering providers. Quality improvement efforts in similar practices will likely require a broad focus on all ordering physicians/nurses.