Emergency departments have become overall diagnostic and treatment centers of excellence and availability in the American health care system. This role has been accentuated in the high-acuity era of COVID-19.
Explore This IssueACEP Now: Vol 40 – No 02 – February 2021
With the surge of telemedicine and other virtual connections with the health system, the ongoing need for centers that provide immediate and unscheduled diagnostic testing to appropriately diagnose and manage new illnesses and injuries has only grown.
The Emergency Department Benchmarking Alliance (EDBA) measures ED utilization of diagnostic testing as the number of procedures performed per 100 patients seen. The latest survey for the year 2019 uses data from approximately 1,000 emergency departments that together saw 50 million patients and reports the results in cohorts based on facility type and on volume of patients seen in those departments (see Table 1).1 These data that capture ongoing changes in utilization and ED flow provide important insights for ED leaders. It is important to note that a variety of quality measures are in place to quantify the use of diagnostic procedures by emergency departments and individual practitioners. While utilization data are a key component of quality measurement, it is essential to consider the differences in the patient population being served by various facilities when any comparisons are made.
Table 1: 2019 ECG and Imaging Procedure Utilization
|ED Type||ECGs per 100 Patients||MRI Procedures per 100 Patients||Ultrasound Procedures per 100 Patients||CT Procedures per 100 Patients||Simple Radiograph Procedures per 100 Patients|
|All EDs (n=1,400)||28||1.8||7||27||48|
|Under 20k Volume||22||0.6||4||18||37|
|Over 100k Volume||35||3.3||8||20||40|
Diagnostic Test Utilization
Use of diagnostic testing was first reported by the EDBA in ACEP Now in 2017.2 Table 1 shows EDBA data on the utilization of diagnostic testing based on volume of patients served and population served. There have been significant increases in use of diagnostic testing in adult-serving emergency departments compared to facilities serving pediatric populations. For example, pediatric emergency departments only use CT imaging procedures approximately four times per 100 patients seen, while adult-serving emergency departments have 32 uses per 100 patients. Emergency departments with annual volumes over 40,000 patients also turn to testing more frequently.
Utilization of ECGs also continues to increase, according to EDBA figures (see Figure 1), reflecting the increasing percentage of older patients being evaluated in emergency departments and our improved understanding of the variation in how acute coronary syndromes can present.
There is also a trend of increasing utilization of CT scans (see Figure 1), ultrasound, and MRI imaging. MRI utilization across all emergency departments has now grown to around two per 100 patients, and up to 2.5 in higher-volume emergency departments and trauma centers where acuity (and resource availability) may be higher.