Trauma Transfers and Definitive Imaging: Patient Benefit but at What Cost?

Abstract

Many patients undergo computed tomography (CT) scan before transfer to definitive care. Despite this, studies are often repeated on arrival to the trauma center. We evaluated a policy to provide formal in-house interpretation of images performed at outside hospitals. A 3-month retrospective analysis was performed. Two groups were compared. Patients in the in-house interpretation (IHI) group underwent in-house interpretation of outside images. Those images not meeting criteria were placed in the comparison group without in-house radiologic interpretation. Demographics, CT scan data, billing and productivity loss, and extrapolated cancer risk reduction were analyzed. There were no significant differences in demographic or injury data. Fewer total CT scans were performed in the IHI group (223 vs 320, P = 0.04). The IHI group underwent fewer repeated CT scans (25 vs 62, P = 0.02; odds ratio [OR], 0.53). Fewer patients were exposed to repeat CT scans (17 vs 32; OR, 0.48). Total hospital billings decreased by $188,285 ($4,592/patient) in the IHI group. Uncaptured work relative value units totaled 152.19 (3.71/patient) in the IHI group. Radiation exposure decreased by 8 per cent. Use of outside hospital imaging as the definitive evaluation of injured patients is safe and results in an overall decrease in radiation exposure and healthcare cost.

Impact of Trauma Center Designation and Interfacility Transfer on Renal Trauma Outcomes: Evidence for Universal Management

“…Significant direct and indirect costs are associated with interfacility transfer and have important resource utilization implications. Patients who are transferred frequently undergo repeat imaging, resulting in increased radiation exposure, image billing, and total hospital costs [33,34]. Additionally, secondary overtriage has been identified as a potential area of cost escalation [35,36].…”

The Financial and Radiation Burden of Early Reimaging in Neurosurgical Patients: An Original Study and Review of the Literature

“…The quality of the imaging has been described directly (e.g. imaging produced by one- to four-slice scanners providing less resolution, and technologist-dependent errors like contrast timing) and indirectly (via concern for missed injury despite the ability to view OSH imaging) [ 5 , 10 , 11 , 15 , 16 , 30 , 31 , 36 , 41 , 42 ]. One study found that injuries not described by referring hospital scans which were found upon rCT of the same region upon arrival at TCs accounted for 54% of repeat imaging.…”

“…In a study dedicated to the matter, an American College of Surgeons Level I trauma center had in-house radiologists read outside images by way of the electronic medical record (EMR)-ordered consult. They addressed legal concerns by having NTC radiology reports uploaded to complete the consult [ 16 ]. The result was a statistically significant decrease in total CTs, including rCTs and those in every body region except the chest.…”

“…Indeed, as much as 72% of spine imaging is completed in the ED and not ordered by a spine specialist [ 43 ]. Likewise, while CTH was the most commonly repeated study at our institution and throughout the literature, repeat scans are often ordered in the ED by non-neurosurgeons without regard to timing [ 10 , 12 , 16 , 27 , 31 , 47 ]. Serial radiological exams play an important part in monitoring cranial injury; however, the propensity of non-neurosurgical staff to order repeat scans prematurely can contribute to an overall increased rate of CTH.…”

“…As previously discussed, hospital policies may prevent in-house radiologist interpretation of transferred imaging. Quick et al completed a study to evaluate a change in policy allowing for in-house interpretation (IHI) of OSH images; the result was a 56% reduction in rCTH, an 8% decrease in radiation exposure, and a $4,592 decrease in billing per patient [ 16 ]. Though challenges exist and the scope of implementation may be limited, for those systems in which radiologists, specialists, and hospital administrators may find an agreeable compromise, IHI of OSH images addresses the concern of NTC-radiologist inexperience as well as allowing for communication between TC physicians and the interpreting radiologist.…”