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Advanced Imaging Not At Fault For Packed EDs

June 27, 2012
Written by: , Filed in: Emergency Radiology, Practice Management
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Researchers have studied the rapidly increasing crowding in U.S. emergency departments over the past decade, and guess what? They blamed factors other than advanced imaging.

Were you expecting a different result? The researchers certainly were. Stephen Pitts, MD, the study’s lead author, admitted:

We were surprised that ordering blood tests and administering IV fluids, along with other aspects of patient care, contributed more to crowding than advanced imaging.

Thanks. We think.

Dr. Pitts is an associate professor in the emergency medicine department at the Emory University School of Medicine in Atlanta. He was quoted in an American College of Emergency Physicians news release. Last week, Annals of Emergency Medicine published online the ED study by Dr. Pitts and three colleagues.

The researchers looked at 2001–2008 data from the annual National Hospital Ambulatory Medical Care Survey, conducted by the Centers for Disease Control and Prevention. During that period, the study found, emergency department visits increased 60 percent faster than population growth, going up by 1.9 percent a year. And mean occupancy—or crowding—went up even faster: by 3.1 percent a year.

Advanced imaging did grow by 140 percent over the study period. And the study did conclude: “A major driver of the increase in ED occupancy is rapid growth in the use of advanced imaging, particularly CT scanning.”

Such imaging particularly aggravates ED crowding because in that setting it cannot be scheduled in advance, the study said. “However, we found that the net effect of advanced imaging on ED occupancy was smaller than that of several other throughput factors, including more frequent ordering of blood tests, administration of intravenous fluids, performance of clinical procedures, and visits with 2 or more medications mentioned.”

Some of those procedures were supposed to streamline the ED process. “Ironically,” Dr. Pitts said, “it is possible that innovations intended to speed patients through the ER, such as authorizing the early ordering of blood work and X-rays at triage, may be bogging down patient flow instead.”

You just can’t escape the long arm of the law of unintended consequences.

Dr. Pitts did find real cause for alarm in the study:

A rapidly rising tide of older, sicker patients combined with an increasingly interventionist practice style is putting enormous pressure on a shrinking supply of emergency departments. This has ominous implications for patient safety and access to emergency care in the U.S.

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Related seminar: Emergency Radiology

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