Influence of CT utilisation on patient flow in the emergency department: a retrospective 1-year cohort study

Li, Chao-Jui; Syue, Yuan-Jhen; Lin, Yan Ren; Cheng, Hsien-Hung; Cheng, Fu-Jen; Tsai, Tsung‐Ting; Chen, Kuan-Fu; Lee, Chien-Hung

doi:10.1136/bmjopen-2015-010815

Cited by 12 publications

(24 citation statements)

References 20 publications

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“…Neal et al have reported results suggesting that abdominal CT performed before laparotomy is associated with higher mortality. In contrast, another study showed that CT scan reduced admission time to ICU in some patient groups . In our study, imaging studies were not linked to higher mortality even though they were linked to delayed ICU admission.…”

Section: Discussioncontrasting

confidence: 91%

Factors related to delayed intensive care unit admission from emergency department—A retrospective cohort study

Aitavaara-Anttila

Liisanantti

Raatiniemi

et al. 2019

Acta Anaesthesiol Scand

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Background:The delays in transferring patients from emergency department (ED) to intensive care unit (ICU) are known to be linked with several adverse events, including prolonged ICU stay and increased hospital mortality. The factors associated with delayed ICU admission include shortage of ICU beds, organizational factors, ED overcrowding, and patient-related factors, including sepsis as admission diagnosis. The aim of this study was to examine ED-related factors associated with prolonged ED stay. Methods: The study population consisted of adult patients admitted (n = 479) from ED to ICU between 31 May 2016 and 19 March 2017 in Oulu University Hospital. A patient's ED length of stay (LOS) exceeding 180 minutes was considered delayed. Results: Most of the patients (380, 79.3%) were admitted to the ICU within 3 hours of hospital admission. In a logistic regression analysis, odds ratios (ORs) for ED LOS > 180 minutes were as follows: for Glasgow Coma Scale score > 9, 2.73(1.39-5.32); for thrombocytes < 100 × 10 9 /mmol, 6.69 (2.32-19.26); for absence of pre-arrival notification, 5.27 (3.04-9.14); and for radiological examination, 3.95(1.72-9.10). Trauma and intoxicated patients had shorter ED LOS while patients with medical conditions had more often prolonged admissions. Conclusion:The delays in ICU admissions were linked to therapeutic and diagnostic procedures and absence of pre-arrival notification. Patients were admitted to the ICU on the basis of diagnosis instead of clinical risk. However, the delays were not associated with worsening outcome, which indicates that sufficient care can be provided at the ED while the ICU admission is pending.

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Section: Discussioncontrasting

confidence: 91%

Factors related to delayed intensive care unit admission from emergency department—A retrospective cohort study

Aitavaara-Anttila

Liisanantti

Raatiniemi

et al. 2019

Acta Anaesthesiol Scand

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“…[2][3][4] CT may increase patient length of stay when discharged from high turnover areas such as the emergency department (ED). 5 In spite of these potential harms, up to 72% of CTPAs to rule out PE in the ED may be avoidable. 6 Several key stakeholders have attempted to enact policies to address overuse of CTPA.…”

Section: Introductionmentioning

confidence: 99%

Qualitative Study to Understand Ordering of CT Angiography to Diagnose Pulmonary Embolism in the Emergency Room Setting

Gyftopoulos

Smith

Simon

et al. 2018

Journal of the American College of Radiology

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EM providers were the main drivers of CTPA ordering, and there was a marginalized role for the radiologist. Experience- and gestalt-based heuristics were the main influencers of CTPA ordering. Our findings suggest that a more nuanced intervention than simply including a d-dimer and a prediction score in each preimaging workup may be necessary to curb overordering of CTPA in patients suspected of PE.

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“…Despite many endeavors to make less use of CT, EPs still insist on using the technique, either to avoid malpractice litigation or else because it is a readily available and rapid diagnostic guide (19,20). Also, the use of CT appears to significantly reduce waiting times in the ED among patients requiring to be admitted for treatment in clinics (21). In our study, 85.4% of patients undergoing radiological imaging were discharged.…”

Section: Discussionmentioning

confidence: 68%

“…Presentations to the ED occurred after 17:00 h in 62.8% of adults and 72.5% of children in one study (22). Another study reporting that 59.5% of patients arrived at after-hours determined a rate of CT of 54.5% within that time frame (21). The primary aim behind the teleradiology use is to support EPs in terms of diagnosis after-hours (7).…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Analysis of Patients Receiving Teleradiology Consultations for Computed Tomography in the Emergency Department

Turgut¹,

Bucak²,

Almış³

et al. 2019

Istanbul Med J

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Amaç: Teleradyolojinin, acil servislerde hastalara zamanında ve doğru tanı konmasında önemli bir işlevi vardır. Bu çalışmamızda acil hekiminin teleradyolojiyi daha çok hangi durumlarda kullandığını inceleyerek, acil servislerde teleradyoloji kullanımını etkileyen faktörleri tespit etmek istedik. Yöntemler: Bir ay boyunca acil servislerde çekilen bilgisayarlı tomografi (BT) görüntülerini retrospektif olarak inceledik. Acil hekiminin teleradyolojiden hemen raporlama istediği (grup 1) ve raporlama istemeyip kendisinin değerledirdiği hastaları (grup 2); demografik özellikleri, şikayetleri, sonlanımları ve tekrar başvuru açısından karşılaştırdık. Bulgular: Çalışmada toplam 1999 hasta olup, bunların 831'i grup 1 1168'i ise grup 2'ye aittir. Grup 2'deki (42,87±25,12 yıl) hastalar grup 1'dekilerden (38,78±25,03 yıl) daha yaşlıdır (p<0,01). Adli olgularda raporlanma oranı (%85,8) adli olmayanlara göre anlamlı düzeyde daha yüksektir (p<0,05). Acil hekimleri en fazla raporlamayı karın ağrısı şikayetiyle hastaneye başvurup abdomen BT çekilen hastalara istemiştir (p<0,05). Acil hekimi hastaneye yatırılan ve ölen olgulara taburcu olanlara göre daha fazla raporlama talep etmiştir (p<0,05). Teleradyoloji konsültasyonu yapılmadan taburcu edilen olguların acile tekrar başvuru oranı, teleradyolojiye konsülte edilip taburcu edilenlerinkinden anlamlı düzeyde daha yüksektir (p=0,01). Sonuç: Bu araştırmada, adli olgularda, karın ağrılı hastalarda, hastaneye yatırılarak tedavi edilmesi gereken hastalarda ve mesai dışındaki saatlerde acile başvuran hastalarda teleradyolojinin daha fazla kullanıldığını tespit ettik. Anahtar Kelimeler: Acil, teleradyoloji, bilgisayarlı tomografi, karın ağrısı Introduction: Teleradiology plays an essential role in the accurate and prompt diagnosis of patients in the emergency department (ED). This study aimed to analyze some factors affecting the use of teleradiology in EDs. Methods: We retrospectively examined computerized tomography (CT) images taken in our ED over one month. We compared patients for whom emergency physicians (EP) requested an immediate report via teleradiology (group 1), and patients for whom they requested no report and assessed themselves (group 2), in terms of demographic characteristics, complaints, outcomes, and re-admission. Results: The study population consisted of 1999 patients, 831 in group 1, and 1168 in group 2. The patients in group 2 were older (42.87±25.12 years) than those in group 1 (38.78±25.03 years) (p<0.01). The proportion of reports issued in forensic cases (85.8%) was significantly higher than that in non-forensic cases (p<0.05). EPs most commonly requested reports for patients presenting to the hospital due to abdominal pain (p<0.05). EP requested significantly more reports for patients admitted to the hospital and for subjects who died (p<0.05). The re-admission rate among patients who were discharged without teleradiology consultation was higher than the re-admission rate of those who were discharged after the teleradiology consultation (p=0.01). Conclusion: Our...

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Influence of CT utilisation on patient flow in the emergency department: a retrospective 1-year cohort study

Cited by 12 publications

References 20 publications

Factors related to delayed intensive care unit admission from emergency department—A retrospective cohort study

Factors related to delayed intensive care unit admission from emergency department—A retrospective cohort study

Qualitative Study to Understand Ordering of CT Angiography to Diagnose Pulmonary Embolism in the Emergency Room Setting

A Retrospective Analysis of Patients Receiving Teleradiology Consultations for Computed Tomography in the Emergency Department

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