So many difficulties have cropped up in the emergency department (ED) during the almost three years of the pandemic. However, there is good news: many ED diagnostic test turnaround times have improved.

Improving Hospital Operations

Hospital leaders are looking to the ED for improved operations and flow of patients moving into inpatient units or being discharged. ED physicians are being called on to provide guidance on efficiency and the ability to reduce bottlenecks and frustrations for hospital staff. The performance of emergency departments in 2020 and 2021 has been summarized by the Emergency Department Benchmarking Alliance (EDBA) in its annual survey report. One of the operational challenges that occurred in the pandemic years was a marked change in the average daily volumes presenting to departments. After an initial decrease in ED volumes, subsequent ED patient counts seemed to change rapidly, and most EDs saw an increase in acuity.¹

The EDBA data survey for 2021 was the third year that data were collected and reported on turnaround times for testing in the ED. Trends are generally good. (See the EDBA data in the slideshow above.)

TAT for Select Laboratory Diagnostic Tests

For radiology, the turnaround time (TAT) for select metrics is reported as a median time interval from “order placed in EHR (electronic health record) by ED provider” to “first result available to ED provider.” For imaging procedures, the results-available time stamp may be when a “preliminary” or “final” report is complete, depending on the ED’s policy of decision-making for a given imaging modality.

The EDBA collected and reported data for the following imaging procedures:

• Plain X-ray imaging
• Ultrasound procedures
• CT procedures
• MRI procedures

The EDBA survey collects data based on the median time interval from “order for diagnostic test placed in EHR by ED provider” until “first result available to ED provider.” The laboratory diagnostic tests in the survey are the following:

• Complete blood count
• Basic metabolic panel
• Lactate
• Troponin
• Urinalysis

The intervals reported for imaging procedures and laboratory tests are all median times, reported in minutes. The EDBA survey reports in the usual cohorts used by the Alliance over many years, first reported in 2014.² There are differences by volume cohorts, and in pediatric and adult-serving EDs.

The survey indicates that turnaround time performance improved on many radiology measures, shortening from 2019 to 2021. Notable exceptions include the turnaround time for CT procedures, which increased by a few minutes across the board in 2021 and for imaging at pediatric facilities. A possible explanation could be the increase in CT volume compared to prior years.

Quick diagnostic test results are important to the practice of emergency medicine, as it provides critical information related to acute medical conditions and allows the emergency physician and consultants to have information necessary for quality ED decision making and disposition. Shorter intervals for diagnostic testing can ultimately improve patient flow for all patients.

These diagnostic-test turnaround times from EDBA should give emergency physician leaders the opportunity to compare the times in their own institutions. One area for uncluttering the emergency department is improving the turnaround time for diagnostic tests. The EDBA annual survey found a slight trend toward improvement in turnaround times from 2019 to 2021. ED leaders should discuss methods to further improve with the leaders of radiology and laboratory services, and work with hospital leaders to improve overall patient flow.

Dr. Augustine is national director of prehospital strategy for US Acute Care Solutions based in Canton, Ohio; clinical professor of emergency medicine at Wright State University in Dayton, Ohio; and vice president of the Emergency Department Benchmarking Alliance.

References

1. Augustine JJ, Jouriles NJ. First look: emergency department operations in the pandemic year 2021. ACEP Now. 2023;42(1).
2. Augustine JJ. Expanded diagnostic testing in the emergency department raises need for cohort data. ACEP Now. 2014;33(5).