Inefficient Resource Use for Patients Who Receive Both a Chest Radiograph and Chest CT in a Single Emergency Department Visit

Hanna, Tarek N.; Shuaib, Waqas; Kerchberger, James Matthew; Johnson, Jamlik-Omari; Khosa, Faisal

doi:10.1016/j.jacr.2015.06.027

Cited by 9 publications

(4 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Potential benefits of dedicated onsite emergency radiologists in the ED include consultation about appropriate imaging, minimizing unnecessary imaging, choosing the most suitable imaging modality and improved report turnaround time. [18][19][20] At our institution, emergency staff radiologists also triage advanced imaging requests, prioritizing the more urgent cases and supervise CT image acquisition of severely ill patients in the technologist control room in order to modify the CT protocol in case of unexpected findings and to give an immediate verbal report (''wet read'') to the requesting physicians. In-house staff radiologists supervise trainees allowing rapid review and finalization of reports and reducing the risk of clinicians making management decisions based on discrepant preliminary reports.…”

Section: Discussionmentioning

confidence: 99%

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

et al. 2021

Self Cite

View full text Add to dashboard Cite

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The chest X-ray appears to be the most performed radiological examination for patients admitted in the ED, being carried out in 35.4% of all admitted patients and applied at >70% of visits with acute cardiothoracic symptoms and signs compared to the 13% of cases in which a CT is carried out as the first exam. 14,15 Chest X-ray is described by several researchers as a useful tool to show cardiovascular findings in both cases with cardiovascular diagnostic inquiry and cases with different original indications as unexpected additional findings (incidentaloma). 16,17 The incidentaloma represents a dilemma for radiologists – although some recommend not reporting imaging findings that do not have clinical relevance, others consider it important to describe all available information in order to ensure it is available to the referring physician within the context of the clinical history.…”

Section: Discussionmentioning

confidence: 99%

Acute aortic syndrome and radiology liability in Italy: Case reports and medico-legal considerations

et al. 2021

View full text Add to dashboard Cite

The trend for medical malpractice claims has increased in recent years, both in the USA and in Europe. Although diagnostic radiology is not considered a high-risk field, malpractice claims in this area follow this general trend. The most common legal action taken against radiologists includes failure to diagnose, poor communication between physicians, failure to supervise technologists properly and improper procedures. Recently, the Italian Civil Supreme Court delivered a judgment (Cass. Civ., N.10158-18) regarding the liability of radiologists, stating that in radiological practice, a correct and timely execution of the diagnostic investigation is required. By contrast, the same judgment states that requesting further clinical consultations and/or the execution of in-depth diagnostic examinations are not within their duties. Considering this judgment, we report two cases of radiologist malpractice and related responsibility for negligent conduct regarding the diagnosis of thoracic aortic dissection and the prevention and management of acute aortic syndrome.

show abstract

“…47,48 Overall, this process may also introduce delays in the reporting of the studies of other patients in the emergency department, thus increasing patient turnaround time and potentially leading to overcrowding, bed shortages, and a potential negative impact patient care. 49 -53…”

Section: Discussionmentioning

confidence: 99%

Evaluating Radiology Result Communication in the Emergency Department

et al. 2020

Self Cite

View full text Add to dashboard Cite

Purpose: To assess the pattern of result communication that occurs between radiologists and referring physicians in the emergency department setting. Methods: An institutional review board–approved prospective study was performed at a large academic medical center with 24/7 emergency radiology cover. Emergency radiologists logged information regarding all result-reporting communication events that occurred over a 168-hour period. Results: A total of 286 independent result communication events occurred during the study period, the vast majority of which occurred via telephone (232/286). Emergency radiologists spent 10% of their working time communicating results. Similar amounts of time were spent discussing negative and positive cross-sectional imaging examinations. In a small minority of communication events, additional information was gathered through communication that resulted in a change of interpretation from a normal to an abnormal study. Conclusions: Effective and efficient result communication is critical to care delivery in the emergency department setting. Discussion regarding abnormal cases, both in person and over the phone, is encouraged. However, in the emergency setting, time spent on routine direct communication of negative examination results in advance of the final report may lead to increased disruptions, longer turnaround times, and negatively impact patient care. In very few instances, does the additional information gained from the communication event result in a change of interpretation?

show abstract

Inefficient Resource Use for Patients Who Receive Both a Chest Radiograph and Chest CT in a Single Emergency Department Visit

Cited by 9 publications

References 20 publications

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

Acute aortic syndrome and radiology liability in Italy: Case reports and medico-legal considerations

Evaluating Radiology Result Communication in the Emergency Department

Contact Info

Product

Resources

About