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• Diagnostic Testing Usage Data Can Help Emergency Physicians Manage Utilization

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ACEP Now: Vol 40 – No 02 – February 2021

(click for larger image) Figure 2: Median Diagnostic Imaging Turnaround Times (Minutes)

To further characterize performance, hospitals were sorted based on trauma center designation. CT scans are used more frequently in Level I and II trauma centers, especially in facilities that also serve as high-level stroke centers and see a greater proportion of adults. There are 31 CT procedures per 100 patients in Level I and II trauma centers, and around 22 procedures in lower-level and nontrauma centers. ED leaders should be aware of the differences and, when called upon to study institutional utilization, should compare their experience to cohorts at a similar level of trauma designation and pediatric mix. 

Diagnostic Imaging Turnaround Times

In 2019, EDBA assembled its first collection of data on turnaround times for select radiology and laboratory metrics. Turnaround time is defined as the median time interval from order placed in the electronic health record by the ED staff to first result available to the ED staff. For imaging procedures, this may be when the “preliminary” or “final” results are available, depending on the emergency department’s policy of decision making for a given imaging modality. The intervals are presented in Figure 2 for routine radiographs, CT scans, MRI scans, and ultrasound procedures, with all displayed as median time elements in minutes. There are important time differences, and like many other elements of ED processing, they are shorter in the lower-volume emergency departments. Because this is the first year this data set has been reported, there are no trending graphs.

The emergency department is the diagnostic center for the medical community. This role is particularly important for patients who have the greatest need for timely evaluation and treatment and might require hospitalization.

The emergency department is the diagnostic center for the medical community. This role is particularly important for patients who have the greatest need for timely evaluation and treatment and might require hospitalization. Because about 67 percent of inpatients are processed through the emergency department, emergency physicians are responsible for a disproportionate share of diagnostic testing and related patient flow issues. 

Emergency physicians should understand the typical utilization rates and turnaround times for diagnostic testing in their department. Now, thanks to new data, departments can see how their utilization practices compare to similar ones around the nation. It is hoped that this will allow better decision making about diagnostic imaging use as a marker of quality and lead to productive discussions with the hospital’s imaging department about ensuring turnaround times are appropriate.