To further characterize performance, hospitals have been sorted based on trauma center designation (see Table 3). The four cohorts are adult-serving Level I and II trauma centers, all Level I and II trauma centers, Level III and IV trauma centers, and all other emergency departments. A comparison of these cohorts finds that designation of the hospital as a Level I or II trauma center is associated with a significant increase in the utilization of diagnostic imaging. In the subset of trauma centers serving a population that is almost exclusively adults, there is a further increase in the use of imaging.
The management of trauma volumes is associated with an overall increase in the acuity of patients as measured by the percentage of patients who are reported as CPT code 99284, 99285, or 99291 (high acuity). Trauma designation also results in higher arrival rates by EMS, higher admission rates, and longer median lengths of stay for all patients served in the emergency department. There is about a 30 percent difference in CT utilization based on higher-level trauma center status and a doubling of the use of MRI procedures.
The emergency department has a critical and growing role as the diagnostic center for the medical community. This role is particularly important for patients who are being evaluated for potential admission to the hospital related to an acute episode of injury or illness. Because about 66 percent of inpatients are processed through the emergency department, physicians are responsible for a disproportionate share of diagnostic testing and the patient-flow issues related to it. Emergency physicians must understand the data on diagnostic testing in their department and have comparison data available. This will allow for better decision making by all parties involved in utilization management and the rate of use of diagnostic imaging as a marker of quality.
- Wiler JL, Welch S, Pines J, et al. Emergency department performance measures update: proceedings of the 2014 Emergency Department Benchmarking Alliance Consensus Summit. Acad Emerg Med. 2015;22(5):542-553.