QIPS Article Spotlight

Jean Scofi, MD MBA is completing her fellowship in Emergency Medicine Administration at the Yale School of Medicine in June 2020 and will be starting an academic position as the Assistant Director of Quality Assurance and Assistant Director of the Healthcare Leadership and Management Fellowship in the Department of Emergency Medicine at Weill-Cornell Medical Center in New York City. Dr. Scofi completed her medical degree from the Keck School of Medicine at the University of Southern California, her business degree at the Yale School of Management, and trained at the Mount Sinai Health System in New York, where she served as Chief Resident. Her academic interests include hospital operations, process improvement, and health informatics. Dr. Scofi is passionate about women in leadership. She has served as the Student Body President at the Keck School of Medicine, the Resident Member of the Society for Academic Emergency Medicine (SAEM) Board of Directors, Chair of the SAEM Resident and Medical Student Education Committee, Chair of the SAEM Resident and Student Advisory Committee, and Co-Chair of the SAEM Didactics Sub-Committee. She is the recipient of the 2013 American Medical Association (AMA) National Leadership Award for Excellence in Medicine, the 2016 American College of Emergency Physicians (ACEP) Resident Leadership and Advocacy Award, and the 2018 Academy for Women in Academic Emergency Medicine (AWAEM) Outstanding Resident Award. 

Over the past decade, the Choosing Wisely campaign has put a national spotlight on issues surrounding resource stewardship in healthcare. In 2013 and 2014, ACEP released ten evidence-based Choosing Wisely recommendations, half of which focused on imaging. This prompted a wave of quality improvement efforts to reduce unnecessary X-rays, CTs, and MRIs in EDs across the country. However, these efforts were highly varied and lacked national benchmarks for comparison. To address this gap, ACEP's Emergency Quality Network (E-QUAL) created the “Avoidable Imaging Initiative” in 2016. Participating EDs report benchmarking data for imaging utilization, receive toolkits for implementing quality improvement practices, and join a learning collaborative to disseminate best practices for imaging stewardship. 

A recent study by Ventakesh and Scofi et al. in the American Journal of Emergency Medicine analyzed the impact of this initiative in 305 EDs across the United States. This was the first study of its kind to describe a national effort to establish benchmarking data and imaging utilization best practices for specific clinical targets. Across all participating EDs, the national average CT rate was 19% for atraumatic low back pain, 50% for syncope, and 73% for minor head injury in 2017-2018, representing relatively high imaging rates consistent with regional studies. ED sites that consistently participated in the E-QUAL Avoidable Imaging Initiative showed significant reductions in CT utilization for syncope and minor head injury, but no significant change in imaging for low back pain. Practice variation among EDs was also high, underscoring the importance of identifying national benchmarks to help contextualize quality improvement efforts. Participation in the E-QUAL initiative is currently voluntary and data is self-reported. In the future, the authors hope to expand the number of participating EDs and report imaging utilization data for even more clinical targets, with the hope of promoting data-driven benchmarking and sustained practice improvements.