Does shifting to professional emergency department staffing affect the decision for chest radiography?

Abstract

BACKGROUND: The study aims to determine whether shifting to professional emergency department (ED) teams leads to a higher rate of radiologic workup. METHODS: We retrospectively analyzed a total of 2,000 patients presenting to the ED of a tertiary teaching hospital in two time periods: group 1 (G1) comprised 1,000 consecutive patients enrolled from December 21, 2012 to January 5, 2013 (all patients were examined by an internal medicine specialist); group 2 (G2) comprised 1,000 consecutive patients enrolled from December 21, 2018 to January 3, 2019 (all patients were examined by an emergency physician). RESULTS: The chest X-ray (CXR) was performed in 40.6% of all patients. There was no difference in the frequency of CXR (38.9% in G1 vs. 42.3% in G2, P=0.152). More CXRs were performed in G2 patients older than 65 years, in female patients older than 65 years, in patients presenting during the evening and night shifts or off-hours, in patients with a history of malignancy, in patients with gastrointestinal bleeding, and in patients with bradycardia, but fewer in patients presenting with arrhythmia. No diff erence in the rates of pathological CXR was found (47.3% in G1 vs. 52.2% in G2, P=0.186). Compared with G2, higher sensitivity and specifi city were obtained for the binary logistic regression model predicting pathological fi ndings in G1. CONCLUSIONS: Shifting to professional ED teams does not increase radiologic workup. By implementing deliberate usage of ultrasound, some self-governing procedures, case-oriented investigations, and center-specifi c recommendations, unnecessary radiologic workup can be avoided. Professional ED teams could lead to a higher standard of emergency care.

Predictors of prolonged adult hospitalization in the tertiary care hospital emergency department of Saudi Arabia ‎

“…This finding can be explained that older adults have lesser immunity and multimorbidity; therefore, they take more time to recover or become stable before being shifted to the next level of care or discharged from the hospital. Besides, it has been previously reported that older patients have conditions that are more acute and require more emergency resources and more biological and x-ray tests than younger patients, thus requiring longer stay in ED [33][34][35]. Another explanation for this finding might be related to problems in communication, with more time being required to obtain a complete history and perform the physical examination among older patients when compared to younger patients [3].…”