Factors associated with imaging overuse in the emergency department: A systematic review

Tung, Monica; Sharma, Ritu; Hinson, Jeremiah S.; Nothelle, Stephanie; Pannikottu, Jean; Segal, Jodi B

doi:10.1016/j.ajem.2017.10.049

Cited by 41 publications

(45 citation statements)

References 40 publications

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“…Both health systems offer universal healthcare. In the USA, a recent systematic review of determinants of imaging in the ED found that imaging overuse was greater in older patients . Comparing geriatric services and testing practices across different systems of care would be valuable in the identification of practices that can reduce variation between hospital ED.…”

Section: Discussionmentioning

confidence: 99%

Predictors of a long length of stay in the emergency department for older people

Sweeny

Keijzers

O’Dwyer

et al. 2020

Internal Medicine Journal

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Background Dedicated geriatric models of care are becoming more prevalent due to the complexity of, and increase in, acute healthcare presentations for older patients. For older people, a long stay in the emergency department (ED) may reflect the complexity of their presentation, or deficiencies in systems that manage these complexities. Aims To identify predictors of a long ED length of stay (LLoS) for patients ≥65 years old. Methods Linked hospital information systems data from a large, public Australian ED were analysed in this retrospective cohort study. LLoS was defined as the 75th percentile (617 min). Multivariate regression identified LLoS predictors for admissions and discharges separately. Results Of 16 791 ED presentations made by older people, 4192 experienced a LLoS; 55% were admitted. Increasing age was associated with an increasing ED LoS. Factors most predictive of LLoS for both admitted and discharged patients included: investigations (both pathology and imaging), less urgent Australasian triage scale categories and after‐hours arrival. Ambulance arrival did not increase the risk of a LLoS for patients eventually admitted, but conferred nearly a twofold increased risk for a LLoS for discharged older persons (adjusted odds ratios = 1.9; 95% confidence interval 1.5–2.4). Conclusions This study assists clinicians and decision‐makers to identify reasons why older persons have a LLoS, whether admitted or discharged. Interventions to streamline care for older patients arriving after‐hours and who require imaging and pathology are required. LoS targets should consider age distribution. The use of ED LoS as a quality of care indicator should be assessed for admissions and discharges, separately.

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Section: Discussionmentioning

confidence: 99%

Predictors of a long length of stay in the emergency department for older people

Sweeny

Keijzers

O’Dwyer

et al. 2020

Internal Medicine Journal

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“…Assessing these strategies and their effectiveness at reducing imaging is a popular topic in the literature with several systematic reviews having been published. However, this literature frequently focuses on specific pathologies (e.g., CT use in acute low-back pain patients), includes multiple imaging modalities, or reviews the incidence of low-value testing in general without addressing potential solutions [7,[10][11][12][13][14][15].…”

Section: Description Of the Existing Intervention Datamentioning

confidence: 99%

A Systematic Review Protocol to Determine the Most Effective Strategies to Reduce Computed Tomography Usage in the Emergency Department

Elzinga¹,

Dunne²,

Vorobeichik³

et al. 2020

Cureus

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This study describes the protocol for a systematic review and meta-analysis. The primary objective of the review is to identify experimental studies assessing the effectiveness of interventions that aim to reduce the proportion of computed tomography (CT) in emergency departments (EDs). Data permitting, our secondary objectives will be to assess the impact of reduction in CT utilization on the length of stay, admission to hospital, and uptake/satisfaction with the intervention. When available, balancing measures such as readmission to hospital or ED revisit rates will be included. Pre-defined subgroup analyses include patient populations (adult or pediatric), type of ED, and the nature of the intervention. Through this review, the research team aims to inform knowledge translation initiatives aimed at lowering CT usage in the ED by identifying the most effective interventions to safely improve CT resource stewardship.

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“…A recent review has identified three factors that predisposes the overuse of radiological imaging in emergency departments-poor integration of services, overcrowding or reduced staffing levels, and a litigious environment that encourages the practice of defensive medicine (15).…”

Section: Ct Use Has Increased Rapidlymentioning

confidence: 99%

Radiation Safety in Emergency Medicine: Balancing the Benefits and Risks

Azman

Shah

2019

Korean J Radiol

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The use of computed tomography (CT) in emergency departments has increased over several decades, as physicians increasingly depend on imaging for diagnoses. Patients and medical personnel are put at risk due to frequent exposure to and higher levels of radiation, with very little evidence of improvements in outcomes. Here, we explore why CT imaging has a tendency to be overused in emergency departments and the obstacles that medical personnel face in ensuring patient safety. The solution requires cooperation from all emergency care stakeholders as well as the continuous education of doctors on how CT scans help in particular cases.

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Factors associated with imaging overuse in the emergency department: A systematic review

Cited by 41 publications

References 40 publications

Predictors of a long length of stay in the emergency department for older people

Predictors of a long length of stay in the emergency department for older people

A Systematic Review Protocol to Determine the Most Effective Strategies to Reduce Computed Tomography Usage in the Emergency Department

Radiation Safety in Emergency Medicine: Balancing the Benefits and Risks

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