Acute Abdomen in the Emergency Department: Is CT a Time-Limiting Factor?

Wang, David C.; Parry, Craig; Feldman, Michael J.; Tomlinson, George; Sarrazin, Josée; Glanc, Phyllis

doi:10.2214/ajr.14.14057

Cited by 35 publications

(31 citation statements)

References 37 publications

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“…Previous studies of CT oral contrast have been narrow in scope, focusing primarily on trauma, renal colic and appendicitis [20,1,4,18,2,17]. Some evaluations have studied outpatient and undifferentiated oncologic patient groups with mixed results [6,4].…”

Section: Discussionmentioning

confidence: 99%

“…Variation in this timing points to the complexity of the ED care pathway. Wang et al detailed the complex process of length of stay and turnaround time assessments [2]. While the above-mentioned time savings are desired if the diagnostic performance is adequate, patients clearly have varied transit pathways through the ED, and a more detailed analysis would likely be useful.…”

Section: Discussionmentioning

confidence: 99%

“…This, typically necessary, imaging step inherently adds to the time a patient may spend in the ED. In an attempt to improve ED disposition times and throughput, oral contrast optimization has been an area of interest [1,2]. …”

Section: Introductionmentioning

confidence: 99%

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Utility of CT oral contrast administration in the emergency department of a quaternary oncology hospital: diagnostic implications, turnaround times, and assessment of ED physician ordering

Jensen

Blair

et al. 2017

Abdom Radiol

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Purpose To compare studies with and without oral contrast on performance of multidetector computed tomography (CT) and the order to CT examination turnaround time in cancer patients presenting to the emergency department (ED). To our knowledge, oral contrast utility has not previously been specifically assessed in cancer patients presenting to the emergency department. Materials & Methods Retrospective review of CT abdomen examinations performed in oncology patients presenting to the emergency department during one month. CT examinations performed with and without oral contrast were rated by two consensus readers for degree of confidence and diagnostic ability. Correlations were assessed for primary cancer type, age, sex, chief complaint/examination indication, body mass index, intravenous contrast status, repeat CT examination within 4 weeks, and disposition. Turnaround times from order to the start of the CT examination were calculated. Results The studied group consisted of 267 patients (127 men and 140 women) with a mean age of 56 years and a mean body mass index of 27.8 kg/m2. One hundred sixty CT examinations were performed without oral contrast, and 107 CT examinations were performed with oral contrast. There was no significant difference between cases with oral contrast and cases without oral contrast in the number of cases rated as “improved confidence” (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.23–1.31, P=0.17), “improved diagnosis” (OR 0.58, 95% CI 0.20–1.64, P=0.3), “impaired confidence” (OR 3.92, 95% CI 0.46–33.06, P=0.21), or “impaired diagnosis” (OR 2.63, 95% CI 0.29–23.89, P=0.39). The turnaround time in the group receiving oral contrast (mean, 141 min; standard deviation, 49.8 min) was significantly longer than that in the group not receiving oral contrast (mean, 109.2 min; standard deviation, 64.8 min) with a mean difference of 31.8 minutes (P<0.0001). Conclusion On the basis of our findings and prior studies, targeted rather than default use of oral contrast shows acceptable diagnostic ability in the emergency setting for oncology patients. Benefit from oral contrast use is suggested in scenarios such as suspected fistula/bowel leak/abscess, hypoattenuating peritoneal disease, prior bowel surgery such as gastric bypass, and the absence of intravenous contrast administration. Improvement through the use of targeted oral contrast administration also supports the emergency department need for prompt diagnosis and disposition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Utility of CT oral contrast administration in the emergency department of a quaternary oncology hospital: diagnostic implications, turnaround times, and assessment of ED physician ordering

Jensen

Blair

et al. 2017

Abdom Radiol

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“…Several studies have assessed factors responsible for delayed emergency care, and most have implicated imaging. All reports underscore the importance of imaging efficiency and the impact of imaging delays, which increase length of stay and aggravate emergency unit overcrowding, thereby further restricting access to care and ultimately compromising outcomes [2,4,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Notwithstanding the capacity of the modern integrated digital radiology system to facilitate such analyses, there has been limited work on enhancing efficiency in the emergency CT environment. Studies to date have largely been conducted in well-resourced settings and have either assessed overall emergency unit efficiency, with imaging being a step in the broader analysis [6,7,[9][10][11], or evaluated specific components of the imaging workflow, rather than the radiology workflow in totality [6,7,12]. Preceding studies have also tended to employ small sample sizes and varying methodology, with contrasting outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Role of the Integrated Digital Radiology System in Assessing the Impact of Patient Load on Emergency Computed Tomography (CT) Efficiency

2018

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Time-critical management is of particular significance in the trauma and emergency setting, where intervals from patient arrival to diagnostic imaging and from imaging to radiology report are key determinants of outcome. This study, based in the Trauma and Emergency Unit of a large, tertiary-level African hospital with a fully digital radiology department, assessed the impact of increased workload on computerised tomography (CT) efficiency. Sequential, customised searches of the institutional radiology information system (RIS) were conducted to define two weekends in 2016 with the lowest and highest emergency CT workloads, respectively. The electronic RIS timestamps defining the intervals between key steps in the CT workflow were extracted and analysed for each weekend. With the exception of radiologist reporting time, workflow steps were significantly prolonged by increased workload. This study highlights the potential role of the integrated digital radiology system in enabling a detailed analysis of imaging workflow, thereby facilitating the identification and appropriate management of bottlenecks.

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Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact

Franklin

Somand

et al. 2021

JACEP Open

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Emergency department (ED) crowding is recognized as a critical threat to patient safety, while sub‐optimal ED patient flow also contributes to reduced patient satisfaction and efficiency of care. Provider in triage (PIT) programs—which typically involve, at a minimum, a physician or advanced practice provider conducting an initial screening exam and potentially initiating treatment and diagnostic testing at the time of triage—are frequently endorsed as a mechanism to reduce ED length of stay (LOS) and therefore mitigate crowding, improve patient satisfaction, and improve ED operational and financial performance. However, the peer‐reviewed evidence regarding the impact of PIT programs on measures including ED LOS, wait times, and costs (as variously defined) is mixed. Mechanistically, PIT programs exert their effects by initiating diagnostic work‐ups earlier and, sometimes, by equipping triage providers to directly disposition patients. However, depending on local contextual factors—including the co‐existence of other front‐end interventions and delays in ED throughput not addressed by PIT—we demonstrate how these features may or may not ultimately translate into reduced ED LOS in different settings. Consequently, site‐specific analysis of the root causes of excessive ED LOS, along with mechanistic assessment of potential countermeasures, is essential for appropriate deployment and successful design of PIT programs at individual EDs. Additional motivations for implementing PIT programs may include their potential to enhance patient safety, patient satisfaction, and team dynamics. In this conceptual article, we address a gap in the literature by demonstrating the mechanisms underlying PIT program results and providing a framework for ED decision‐makers to assess the local rationale for, operational feasibility of, and financial impact of PIT programs.

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Acute Abdomen in the Emergency Department: Is CT a Time-Limiting Factor?

Cited by 35 publications

References 37 publications

Utility of CT oral contrast administration in the emergency department of a quaternary oncology hospital: diagnostic implications, turnaround times, and assessment of ED physician ordering

Utility of CT oral contrast administration in the emergency department of a quaternary oncology hospital: diagnostic implications, turnaround times, and assessment of ED physician ordering

The Role of the Integrated Digital Radiology System in Assessing the Impact of Patient Load on Emergency Computed Tomography (CT) Efficiency

Emergency department provider in triage: assessing site‐specific rationale, operational feasibility, and financial impact

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