Radiology imaging delays as independent predictors of length of hospital stay for emergency medical admissions

Cournane, Seán; Conway, Richard; Creagh, Donnacha; Byrne, Declan; Sheehy, Niall; Silke, Bernard

doi:10.1016/j.crad.2016.03.023

Cited by 34 publications

(22 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This adds to the body of previous work demonstrating worsened outcomes in minorities and may indicate a potential step in the causal pathway, specifically that the threshold to obtain diagnostic imaging may be higher in minorities than for white patients. Although not well investigated specifically in the ED setting, delays or barriers to appropriate imaging can have unpredictable but negative downstream effects including diagnosis of disease at a more advanced stage [32], longer hospital length of stay [33], or unnecessary hospital admission [34].…”

Section: Discussionmentioning

confidence: 99%

The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey

Ross

Kalia

Chan

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background An established body of literature has shown evidence of implicit bias in the health care system on the basis of patient race and ethnicity that contributes to well documented disparities in outcomes. However, little is known about the influence of patient race and ethnicity on the decision to order diagnostic radiology exams in the acute care setting. This study examines the role of patient race and ethnicity on the likelihood of diagnostic imaging exams being ordered during United States emergency department encounters. Methods Publicly available data from the National Hospital Ambulatory Medical Care Survey Emergency Department sample for the years 2006–2016 was compiled. The proportion of patient encounters where diagnostic imaging was ordered was tabulated by race/ethnicity, sub-divided by imaging modality. A multivariable logistic regression model was used to evaluate the influence of patient race/ethnicity on the ordering of diagnostic imaging controlling for other patient and hospital characteristics. Survey weighting variables were used to formulate national-level estimates. Results Using the weighted data, an average of 131,558,553 patient encounters were included each year for the 11-year study period. Imaging was used at 46% of all visits although this varied significantly by patient race and ethnicity with white patients receiving medical imaging at 49% of visits and non-white patients at 41% of visits (p < 0.001). This effect persisted in the controlled regression model and across all imaging modalities with the exception of ultrasound. Other factors with a significant influence on imaging use included patient age, gender, insurance status, number of co-morbidities, hospital setting (urban vs non-urban) and hospital region. There was no evidence to suggest that the disparate use of imaging by patient race and ethnicity changed over the 11-year study time period. Conclusion The likelihood that a diagnostic imaging exam will be ordered during United States emergency department encounters differs significantly by patient race and ethnicity even when controlling for other patient and hospital characteristics. Further work must be done to understand and mitigate what may represent systematic bias and ensure equitable use of health care resources.

show abstract

Section: Discussionmentioning

confidence: 99%

The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey

Ross

Kalia

Chan

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Razi et al (39) demonstrated how residents are able to perform POC echocardiography not only accurately but also nearly a full 24 h before formal echocardiogram results are available to confirm their findings. Delays in imaging are known to cause increased hospital lengths of stay (47). …”

Section: Discussionmentioning

confidence: 99%

Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now

Sabath

Singh

2016

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

Point-of-care (POC) ultrasonography is considered fundamental in emergency medicine training and recently has become a milestone in critical care fellowship programs as well. Currently, there is no such standard requirement for internal medicine residency programs in the United States. We present a new case and briefly review another case at our institution – a community hospital – in which internal medicine house staff trained in ultrasonography were able to uncover unexpected and critical diagnoses that significantly changed patient care and outcomes. We also review the growing evidence of the application of ultrasound in the diagnosis of a myriad of conditions encountered in general internal medicine as well as the mounting data on the ability of internal medicine residents to apply this technology accurately at the bedside. We advocate that the literature has sufficiently established the role of POC ultrasonography in general internal medicine that there should no longer be any delay in giving this an official place in the development of internal medicine trainees. This may be particularly useful in the community hospital setting where 24-h echocardiography or other sonography may not be readily available.

show abstract

“…Time-critical management is particularly important in acute care, where the intervals from patient arrival to diagnostic imaging and from imaging to radiology report are key determinants of outcome [4]. Norms for the completion of emergency imaging have not been defined.…”

Section: Introductionmentioning

confidence: 99%

“…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%

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

2018

View full text Add to dashboard Cite

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.

show abstract

Radiology imaging delays as independent predictors of length of hospital stay for emergency medical admissions

Cited by 34 publications

References 19 publications

The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey

The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey

Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now

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

Contact Info

Product

Resources

About