Jeffrey Chil-jek Sung MD, Presenter: Nothing to Disclose

Aaron David Sodickson MD, PhD, Abstract Co-Author: Nothing to Disclose

Stephen Ledbetter MD, Abstract Co-Author: Nothing to Disclose

The number of emergency department (ED) patients transferred with outside CT imaging (OCT) increases unfunded workload and raises liability concerns for radiologists. Repeat exams expose patients to additional radiation, increase healthcare costs, delay care and consume valuable ED resources. We characterize the types of OCT submitted for reinterpretation at the receiving institution, and the frequency of and reasons for repeat imaging requests.

We prospectively audited OCTs accompanying ED transfer patients over a 4 month period at our tertiary-care, adult-only Level 1 trauma center. Clinicians completed forms specifying CT type, outside report availability, interpretational discrepancies, repeat imaging requests and reasons for repeat imaging.

During the study period, 383 CT exams were reviewed among 231 transfer patients, with a mean of 2.7 exams per day (range 0-16). Mean patient age was 59 (range 17-92); 57% were male; 43% were done for trauma, 26% for suspected intracranial hemorrhage. Exams included 40% head, 4% maxillofacial, 17% cervical spine, 1% thoracic spine, 2% lumbar spine, 15% chest, 21% abdomen/pelvis. The clinician reported no outside verbal or written report for 38 patients (16%), and report availability was unknown in 4 (2%). Among patients with outside reports (n=189, 82%), interpretational discrepancies were described in 27 (14%). 88 patients (38%) underwent 174 (45%) repeat examinations, with reasons including: inadequate imaging (n=17, 7%); technical issues such as viewer interface or inoperable CD (n=6, 3%); clinical issues such as further lesion characterization or assessment for interval change (n=57, 25%); no reason given (n=13, 6%); more than one reason given (n=5, 2%).

Outside CT imaging among ED transfer patients adds workload and resource requirements on the receiving institution. A communication gap exists between the transferring and receiving institutions, with 16% of patients arriving without written or verbal radiology reports. Interpretational discrepancies exist in 14% of patients with reports. 10% of transfer patients undergo potentially avoidable repeat scanning due to inadequate imaging or technical issues.

More effective methods of transferring outside imaging and reports could improve care for transferred patients, reduce healthcare costs, and streamline operations for the accepting institution.

Sung, J, Sodickson, A, Ledbetter, S, Outside CT Imaging in Emergency Department Transfers: Characterizing the Workload on Radiologists and the Frequency of Repeat Imaging.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6007155.html